实时组织弹性成像技术对原发性肝细胞癌切除术后发生肝衰竭的价值分析

The study of real time tissue elastography for predicting the value of liver failure after hepatectomy in patients with primary hepatocellular carcinoma

目的探讨利用实时组织弹性成像技术(RTE)测得术前肝纤维化指数(LFI)以对原发性肝细胞癌(HCC)患者肝切除术后发生肝衰竭的价值。方法回顾性分析2015年11月至2017年9月间福州总医院行肝切除术的HCC 116例患者资料。所有患者术前均行实验室检查及RTE检查,获取相关实验室指标及LFI,记录术中可能影响术后肝衰竭的指标。按术后是否出现肝衰竭,对相关因素进行单因素分析后行多元线性回归分析,得到术前诊断肝衰竭模型(LFM),并且利用受试者工作特性曲线(ROC)评价其诊断效能。结果 116例中发生肝衰竭17例(14.7%),未发生肝衰竭99例(85.3%)。单因素分析表明总胆汁酸(P=0.008)、国家标准化比值(INR)(P=0.002)、LFI(P=0.006)、是否有肝硬化(P<0.000)及术中出血量(P=0.013)为影响术后发生肝衰竭的因素。多元线性回归分析表明INR和LFI是影响术后肝衰竭发生的独立风险因素,预测方程LFM=1.075×INR+2.050×LFI-11.738。INR、LFI和LFM的ROC曲线下面积分别为0.712(95%CI:0.614～0.797,P=0.0104)、0.690(95%CI:0.597～0.772,P=0.009)和0.839(95%CI:0.759～0.900,P<0.001)。结论术前LFI的测量有助于外科医师判断HCC术后肝衰竭预后及选择合适的治疗方案。

Objective To investigate the usefulness of preoperative liver fibrosis index(LFI)measured by real-time tissue elastography(RTE)in predicting postoperative liver failure(PLF)after hepatectomy for primary hepatocellular carcinoma(HCC). Methods The study included 116 consecutive patients with HCC who underwent hepatectomy between November 2015 and September 2017.Detailed examinations included related laboratory indexes and LFI performed pre-operative and relevant signs performed intra-operative.According to whether liver failure occurred after operation,patients were divided into groups.The univariate analysis was carried out firstly,and then the factors influencing the results were analyzed by multiple linear regression to establish the model of liver failure diagnosis(LFM)and to evaluate diagnostic efficiency by the receiver operating characteristic curve(ROC). Results 17 patients(14.7%)with liver failure and 99 patients(85.3%)without liver failure in 116 patients.Univariate analysis showed that the influencing factors of live failure were total bile acid(P=0.008),INR(P=0.002),LFI(P=0.006),cirrhosis(P<0.000)and hemorrhage(P=0.013).Multivariate linear regression analysis showed that INR and LFI were independent risk factors for postoperative liver failure.The prediction equation was LFM=1.075*INR+2.05 0*LFI-11.738.The AUC of INR,LFI and LFM were 0.712(95%CI:0.614-0.797,P=0.0104),0.690(95%CI:0.597-0.772,P=0.009)and 0.839(95%CI:0.759-0.900,P<0.001),respectively. Conclusion The measurement of LFI can help surgeons to determine the prognosis of HCC after surgery and select the appropriate treatment.