功能性残肝体积预测肝细胞癌患者术后肝功能不全的可行性

Feasibility study of functional residual liver volume in predicting postoperative liver dysfunction in patients with hepatocellular carcinoma

目的应用钆塞酸二钠(Gd-EOB-DTPA)增强MRI(Gd-EOB-DTPA-MRI)对残肝相关指标进行测量评估,来预测肝癌患者术后肝功能不全的发生情况。方法选取2013年5月至2018年12月在合肥市第一人民医院接受肝部分切除治疗的72例肝癌患者。通过Gd-EOB-DTPA-MRI测量并计算肝脏相对强化程度(RE)、全肝体积(LV)、标准肝体积(SLV)及功能性残肝体积(FLV)。统计学处理采用两独立样本t检验,Mann-Whitney U检验和卡方检验。多变量分析采用Logistic逐步回归模型。结果共有72例肝癌患者符合要求纳入研究,其中肝功能不全患者9例,无肝功能不全患者63例。单因素分析提示术前AST、RE及FLV与术后肝功能不全的发生有密切相关。将术前AST值、RE及FLV纳入logistic逐步回归模型分析后发现,FLV(OR=0.572,P<0.05)是术后发生肝功能不全的独立危险因素。结论EOB-MRI测量的FLV对肝癌患者术后肝功能不全具有预测价值。

Objective To predict the occurrence of postoperative liver dysfunction in patients with hepatocellular carcinoma(HCC)by using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(EOB-MRI)to measure and evaluate the related indexes of residual liver.Methods A total of 72 patients with HCC who underwent partial hepatectomy in our hospital from May 2013 to December 2018 were included.The relative enhancement of liver(RE),total liver volume(TLV),standard liver volume(SLV)and functional residual liver volume(FRLV)were measured and calculated by EOB-MRI.The general clinical data and perioperative data of the patients were recorded.Normally distributed data was expressed as mean±standard error,and analyzed by Student’s t-tests.Non-parametric data was expressed as median(interquartile range),and analyzed by Mann-Whitney U test.Categorical data was presented as percentage,and analyzed using Chi-square test for comparison between groups.Logistic stepwise regression model was used for multivariate analysis.Results Among the 72 HCC patients,9 had liver dysfunction and 63 did not.Univariate analysis showed that preoperative aspartate aminotransferase(AST)(P<0.05),RE(P<0.05)and FRLV(P<0.05)were closely related to the occurrence of postoperative liver dysfunction.They were entered into logistic stepwise regression model,and FRLV was found to be the only independent risk factor for postoperative liver dysfunction(OR=0.572,P<0.05).Conclusion FRLV measured by EOB-MRI has predictive value for postoperative liver dysfunction in patients with HCC.