IQQA-Liver对右半肝活体肝移植供肝体积及引流域精准评估的临床价值

Clinical significance of IQQA-Liver in the evaluation of liver volume and hepatic vein territory before live donor liver transplantation with a right lobe graft

目的：探讨IQQA-Liver三维系统对右半肝活体肝移植（LDLT）术前精准评估肝体积及引流域的实用价值。方法分别以手动法及半自动法测量92例供体全肝体积（CTV全、 IQQAV全）及右半肝体积（CTV、 IQQAV），测定门脉右支引流域体积（RPVTV），模拟肝切面及静脉重建方案计算有效的功能肝体积（EFHV），并将这4种术前体积分别与术中体积（IOV）进行对比，采用组间数据配对t检验及组间数据两两相关分析进行数据处理，以P≤0．05为差异有统计学意义。统计分析肝静脉各属支直径与相应引流域的相关性。结果 CTV全与IQQAV全分别为（1356．36±217．81） cm^3和（1368．05±220．78） cm^3，二者相关系数为0．96； CTV与IQQAV分别为（858．06±154．95） cm^3和（847．81±155．14） cm^3，二者相关系数为0．93。 IOV为（726．37±124．33） cm^3， RPVTV为（789．52±148．44） cm^3， EFHV为（822．29±154．79） cm^3。 IQQAV与IOV、 CTV与IOV、 RPVTV与IOV、 EFHV与IOV的相关系数分别为0．82、0．81、0．77、0．81， P均〈0．01。254支手术切面相关血管直径与相应引流域的相关系数为0．73， P≤0．01。结论半自动法所测体积与IOV的相关性良好，肝静脉各属支的直径不能完全反映引流域体积，术前应计算EFHV，为临床提供更精准的术前评估。

Objective To investigate the clinical significance of an IQQA-Liver three dimensional system in the evaluation of hepatic volume and hepatic venous drainage territory before live donor liver transplantation（LDLT） with a right lobe graft. Methods The total hepatic volume and right hemihepatic volume of 92 donors were determined with IQQA semiautomatic method （ IQQAVtotal and IQQAV ） and traditional CT manual method （ CTVtotal and CTV ） . Right portal vein territorial volume （RPVTV） of 92 donors were determined, and efficient functional hepatic volume（EFHV） were obtained by simulating hepatic section and venous reconstruction schedule. The preoperative right hemihepatic volume obtained via four methods were compared with the intraoperative volume（IOV） in LDLT and then evaluated through paired t test and correlation analysis between interclass data. P≤0.05 was considered statistically significant. The relationship of the diameter and the territorial volume of 254 hepatic vein were analyzed. Results The correlation coefficients were 0.96 for CTVtotal and IQQAVtotal and 0.93 for CTV and IQQAV. The correlation coefficients were 0.82, 0.81, 0.77, and 0.81 for IQQAV, CTV, RPVTV, EFHV, and IOV, respectively. The correlation coefficient was 0.73 between the diameter and territorial volume of the hepatic vein（P≤0.01）. Conclusions The hemihepatic volume obtained through IQQA-Liver was associated with IOV. However, the diameter of the tributaries of the hepatic vein cannot completely represent homologous territorial volume. EFHV should be calculated to evaluate a patient′s status before operation is performed.