CAJ | 학술논문

目的应用虚拟肝脏手术规划系统测量肝癌肝切除术后剩余肝脏体积,评估剩余肝脏体积比(STELR)在预测术后肝功能损害的价值.方法回顾性分析2007年4月至2011年10月福建医科大学附属第一医院收治的76例原发性肝癌患者的临床资料,术前利用虚拟肝脏手术规划系统进行虚拟肝切除,测量剩余肝脏体积.应用ROC曲线计算STELR的临界值,利用单因素分析和Logistic回归模型分析各危险因素对术后肝功能损害的影响.结果本方法所测预切除肝脏体积为(489±206)ml,实际切除肝脏体积为(459±199)ml,两者呈正相关(r=0.916,P＜0.05).经量化指标计算,76例患者中,肝功能损害轻度48例,中度19例,重度9例.ROC曲线截断点对应的STELR为53％,STELR≥53％的患者有3％(2/59)发生重度肝功能损害；STELR＜ 53％的患者有41％ (7/17)发生重度肝功能损害,两者比较,差异有统计学意义(x2=5.085,P＜0.05).单因素分析显示手术时间、术中出血量和STELR与肝切除术后肝功能损害程度相关(F -7.227,8.630,13.809,P＜0.05).Logistic回归模型分析表明STELR是重度肝功能损害的独立预测因素(Wald=6.675,P＜0.05).结论 STELR可以有效预测肝癌肝切除术后肝功能损害的风险.
목적 응용허의간장수술규화계통측량간암간절제술후잉여간장체적,평고잉여간장체적비(STELR)재예측술후간공능손해적개치.방법 회고성분석2007년4월지2011년10월복건의과대학부속제일의원수치적76례원발성간암환자적림상자료,술전이용허의간장수술규화계통진행허의간절제,측량잉여간장체적.응용ROC곡선계산STELR적림계치,이용단인소분석화Logistic회귀모형분석각위험인소대술후간공능손해적영향.결과 본방법소측예절제간장체적위(489±206)ml,실제절제간장체적위(459±199)ml,량자정정상관(r=0.916,P＜0.05).경양화지표계산,76례환자중,간공능손해경도48례,중도19례,중도9례.ROC곡선절단점대응적STELR위53％,STELR≥53％적환자유3％(2/59)발생중도간공능손해；STELR＜ 53％적환자유41％ (7/17)발생중도간공능손해,량자비교,차이유통계학의의(x2=5.085,P＜0.05).단인소분석현시수술시간、술중출혈량화STELR여간절제술후간공능손해정도상관(F -7.227,8.630,13.809,P＜0.05).Logistic회귀모형분석표명STELR시중도간공능손해적독립예측인소(Wald=6.675,P＜0.05).결론 STELR가이유효예측간암간절제술후간공능손해적풍험.
Objective To calculate the residoal liver volume using a virtaal liver surgery planning system,and to investigate the value of standardized estimated liver remnant volume ratio (STELR) in prcdicting hepatic dysfunction after hepatectomy.Methods The clinical data of 76 patients with primary liver cancer who were admitted to the First Affiliated Hospital of Fujian Medical University from April 2007 to October 2011 were retrospectivcly analyzed.The virtual resection and residual liver volume measurements were carried out using Liv 1.0 software.The value of STELR in predicting hepatic dysfunction was assessed using receiver operator characteristic (ROC) curves.Effects of different risk factors on postoperative hepatic dysfunction were analyzed using univariate analysis of variance and multivariate Logistic regression models. Results The mean residual liver volumes predicted by the software and resected during operation were (489 ± 206)ml and (459 ± 199 )ml,respectively,with a positive correlation between predicted and actual resection volumes (r =0.916,P ＜ 0.05).Of the 76 patients,48 had mild hepatic dysfunction,19 had moderate hepatic dysfunction and 9 had severe hepatic dysfunction.A critical STELR of 53％ was associated with severe hepatic dysfunction.Severe hepatic dysfunction was detected in 2 out of 59 (3％) patients with STELR ≥ 53％ and 7 out of 17 (41％) patients with STELR ＜ 53％,which represented a significant difference ( x2 =5.085,P ＜ 0.05 ).The result of univariate analysis revealed that STEL,R,operating time,intraoperative blood loss were significant prognostic indicators for severe hepatic dysfunction ( F =7.227,8.630,13.809,P ＜0.05).Multivariate Logistic regession revealed that STELR was a significant independent predictor of severe hepatic dysfunction ( Wald =6.675,P ＜ 0.05 ).Conclusion The likelihood of severe hepatic dysfunction after hepatectomy can be predicted by STELR.