乙肝病毒相关性肝癌术后标准残肝体积及其与术后肝功能代偿不全关系的研究

Study of postoperative standard remnant volume in patients with hepatitis B virus-related hepatocellular carcinoma and its relationship with postoperative compensatory hepatic insufficiency

目的探讨HBV相关性肝细胞癌(HCC)术后标准残肝体积(SRLV)与肝功能代偿不全的关系及术后发生肝功能代偿不全时的SRLV。方法 80例HBV相关性HCC患者分为术后发生肝功能代偿不全组26例,未发生肝功能代偿不全组54例。采用Myrian-Liver手术规划系统对所有进行术前模拟切除,术中排水法测定切除肝脏的体积。比较两组患者的SRLV,分析HCC术后SRLV与肝功能代偿不全的相关性;采用ROC曲线计算术后发生肝功能代偿不全时及不同肝功能代偿不全分级的SRLV临界值。结果模拟预切除的肝脏体积与排水法实际切除的肝脏体积分别为(613.5±47.2)ml、(568.2±41.9)ml,两者比较差异无统计学意义(P>0.05),相关性分析显示HCC术后SRLV与肝功能代偿不全呈正相关性(P<0.05)。术后发生肝功能代偿不全组SRLV为(450.06±148.09)ml/m2,低于未发生肝功能代偿不全组的(534.94±133.10)ml/m2(P<0.05)。术后发生肝功能代偿不全时SRLV的临界值为462 ml/m2,A级及B级肝功能代偿不全的SRLV临界值分别为462 ml/m2、424 ml/m2。结论 SRLV是评估肝脏储备功能的一项重要指标,能准确评估术后肝功能代偿不全的程度以有效降低术后肝功能衰竭的风险。

Objective To explore the relationship of postoperative standard remnant liver volume（ SRLV） with compensatory hepatic insufficiency（ HI） in HBV-related hepatocellular carcinoma（ HCC） and the SRLV when postoperative compensatory HI occurred.Methods Eighty patients with HBV-related HCC were divided into postoperative compensatory HI group（ n = 26） and non-compensatory HI group（ n = 54）. Preoperative simulation hepatectomy was performed by Myrian-Liver Surgery Planning System,and the specimen volumes were measured using intraoperative drainage method. The comparison of SRLV was conducted between two groups. The correlation of SRLV with compensatory HI was assessed after HCC operation. ROC curve was adopted to calculate the critical values of SRLV when postoperative compensatory HI occurred and with different grades of compensatory HI. Results The liver volumes removed with preoperative simulation method and drainage method were（ 613. 5 ± 47. 2） ml and（ 568. 2 ± 41. 9） ml,respectively,and no significant difference was observed between these two methods（ P〉0. 05）. The correlation analysis showed that SRLV positively correlated with compensatory HI after HCC operation（ P〈0. 05）. The SRLV of postoperative compensatory HI group was（ 450. 06 ± 148. 09） ml / m2,which was less than that of non-compensatory HI group（（ 534. 94 ± 133. 10） ml / m2,P〈0. 05）. The critical value of SRLV when postoperative compensatory HI occurred was 462 ml / m2. And the critical value of SRLV with grade A and B of compensatory HI were 462 ml / m2 and 424 ml / m2,respectively. Conclusion SRLV is an important index for evaluating the liver reserve function. It can accurately predict the degree of postoperative hepatic decompensation so as to effectively reduce the risk of postoperative liver failure.