应用影像后处理技术测定脾体积评估原位肝移植缓解脾功能亢进的效果

Application of image post - processing technique to measure spleen volume and evaluate the effect of orthotopic liver transplantation on relieving hypersplenism

目的应用影像后处理技术测定脾体积评估终末期肝病合并不同程度脾功能亢进(脾亢)受者接受原位肝移植后脾亢缓解的效果。方法纳入55例终末期肝病合并脾亢接受原位肝移植的受者,移植前后利用影像后处理系统Advantage Workstation 46(AW46)测定脾体积的变化,观察移植前后脾厚度、门脉流速、血小板计数的变化。结果55例受者移植后脾体积为(562.90±49.16)cm^3,较术前的(850.50±77.99)cm^3显著下降,差异有统计学意义(P<0.05),下降比例为(31.70±2.76)%。术后不同时间点的脾厚度均较术前显著下降(P<0.05),于术后1个月后趋于稳定;脾厚度与脾体积呈正相关(r=0.78,P<0.05)。术后不同时间点的门脉流速均较术前显著增加(P<0.05),于术后1个月达峰值(380.70±21.80)mm/s,之后开始下降并于3个月后趋于稳定。术后不同时间点的血小板计数(PLT)均较术前显著上升(P<0.05),术后2周时达峰值(193.40±10.36)×10^9/L,之后开始回落并于2个月后趋于稳定;脾体积与PLT呈负相关(r=-0.44,P<0.05)。术后10个月内脾亢恢复率为(78.79±2.29)%,复发率为(17.75±2.31)%。结论原位肝移植术能有效缓解终末期肝病合并的脾亢;利用影像后处理系统测定脾体积并结合血常规及超声检查等临床指标可精确对肝移植缓解脾亢的效果进行评估。

Objective To employ image post-processing technique measuring splenic volume for evaluating the mitigation effect of end-stage liver disease patients complicated with different degrees of hypersplenism undergoing orthotopic liver transplantation. Methods For 55 end-stage liver disease patients with hypersplenism undergoing orthotopic liver transplantation, the changes in splenic volume were measured before and after transplantation by image post-processing system Advantage Workstation 46 (AW46) and the changes of splenic thickness, portal flow velocity and platelet counts observed during perioperative period. Results Postoperative splenic volumes of 55 recipients were (562.90±49.16) cm^3, significantly decreased than preoperative (850.50±77.99) cm^3 (P<0.05) and reduction ratio was (31.70±2.76)%. Splenic thickness at different postoperative timepoints was significantly lower than that pre-operation (P<0.05) and stabilized at 1 month post-transplantation;Splenic volume was positively correlated with splenic thickness (r=0.78, P<0.05). Portal flow velocity at different postoperative timepoints increased significantly as compared with preoperative (P<0.05), peaked at (380.70±21.80) mm/s at 1 month post-transplantation, declined and stabilized at 3 months post-transplantation. Platelet counts (PLT) at different postoperative timepoints were significantly higher than those at pre-operation (P<0.05), peaked (193.40±10.36)×10^9/L at 2 weeks post-transplantation, dropped and remained at 2 months post-transplantation;Splenic volume was negatively correlated with PLT (r=-0.44, P<0.05). And hypersplenism recovery rate and recurrence rate within 10 months post-transplantation was (78.79±2.29)% and (17.75±2.31)% respectively. Conclusions Orthotopic liver transplantation can effectively alleviate hypersplenism for most end-stage liver diseases. Using image post-processing system, splenic volume may be calculated and blood routine and ultrasound are simultaneously used for assessing the outcomes of liver transplantation on hypersplenism.