原发性肝癌机械性压迫对邻近肝组织功能的影响

Effect of mechanical compression of primary liver cancer on function of adjacent liver tissue

背景与目的:现有研究表明,肝脏脉管受累以及肿瘤压迫与肝脏区域功能下降密切相关。动态SPECT/CT ^(99m)Tc-半乳糖人血清白蛋白(GSA)显像技术已被证实是一种较为准确的肝脏功能区域评估技术。已有研究利用该技术阐明了肝脏脉管受累后区域功能的变化,但是尚缺乏肿瘤机械性压迫对区域肝功能的定量研究。本研究旨在探讨肿瘤机械性压迫对邻近肝组织功能的影响。方法:回顾性研究分析45例原发性肝癌患者的SPECT/CT影像学以及临床资料,14例患者存在脉管受累或接受过肝脏放射治疗(受累组),31例患者无脉管受累且未接受过肝脏放射治疗(未受累组),在CT图像上距离肿瘤边缘2、4、6 cm画出对应区域(D1、D2、D3)以及半肝相应的区域后计算形态学体积(MLV),将SPECT图像与CT图像进一步融合处理后计算两侧肝叶和D1~D3区域内肝组织的功能性体积(FLV)、功能性肝密度(FLD)及肝细胞摄取速率常数(GSA-K)。比较受累组两侧肝叶和两组内D1~D3区域相关指标。采用相关性分析与多重线性回归分析原发性肝癌邻近肝组织功能的影响因素。结果:受累组肿瘤占据侧肝叶FLV、FLD明显低于另一侧肝叶(均P<0.01);未受累组内D1区域的FLD明显低于D2和D3区域(P<0.01)。相关性分析结果显示,肿瘤直径、肿瘤体积是影响未受累组D1区域FLD值的相关因素(P<0.05);Child-Pugh分级是影响未受累组D2区域FLD的相关因素(P<0.05)。多重线性回归分析结果显示,肿瘤直径是影响未受累组D1区域FLD的主要因素(P<0.05)。结论:肿瘤机械性压迫可能是影响原发性肝癌邻近肝组织功能,从而导致区域肝功能下降的重要因素。当肿瘤直径较大时,临床上可能高估预留肝脏体积处于边缘状态的患者肝切除手术的风险,从而影响此类患者治疗方式的选择。

Background and Aims:Existing studies have shown that hepatic vascular involvement and tumor compression are closely related to the decline of regional liver function.Dynamic SPECT/CT 99mTc-galactosyl-human serum albumin(GSA)imaging has been proved to be a more accurate technique for regional assessment of liver function.Previous studies have used this technique to elucidate the changes of regional liver function after vascular involvement,but there is still a lack of quantitative research on the effect of tumor mechanical compression on regional liver function.The purpose of this study was to investigate the effect of mechanical compression of tumor on the function of its adjacent liver tissue.Methods:The SPECT/CT imaging and clinical data of 45 patients with primary liver cancer were retrospectively analyzed.Of the patients,14 patients had vascular or biliary invasion or received liver radiotherapy(affected group),and 31 patients had no such situations(non-affected group).After the corresponding areas at 2,4 and6 cm from the edge of the tumor(D1,D2,D3)and hemihepatic lobe regions on the CT images were drawn,the morphological liver volume(MLV)of above areas were calculated.Functional liver volume(FLV),functional liver density(FLD)and hepatocyte uptake rate constant(GSA-K)of bilateral lobes and D1-D3 regions were calculated after further fusion of SPECT image and CT image.The relevant variables of liver lobes in affected group and of D1-D3 regions within the two groups were compared.Correlation analysis and multiple linear regression analysis were used to analyze the influencing factors of the function of liver tissue adjacent to primary liver cancer.Results:In the affected group,the FLV and FLD of tumor-bearing lobe were significantly lower than those of the other side(both P<0.01);the FLD of D1 region in non-affected group was significantly lower than that in the D2 and D3 regions(both P<0.01).The results of correlation analysis showed that tumor diameter and tumor volume were related factors affecting the FLD of D1 region in the non-affected group(both P<0.05);Child-Pugh grade was related factor influencing FLD of D2 region in the non-affected group(P<0.05).The result of multiple linear regression analysis showed that tumor diameter was the main factor affecting FLD of D1 region in non-affected group(P<0.05).Conclusion:The mechanical compression of tumor may be an important factor affecting the function of liver tissue adjacent to primary liver cancer and thereby leading to the decline of regional liver function.When the tumor diameter is large,the risk of hepatectomy may be overestimated in patients with marginal reserved liver volume,which affects the choice of treatment for such patients.