中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2013年
1期
15-18
,共4页
标准残肝体积%肝切除术%肝功能不全
標準殘肝體積%肝切除術%肝功能不全
표준잔간체적%간절제술%간공능불전
Standard remnant liver volume%Liver resection%Liver insufficiency
目的 探讨合并肝硬化肝细胞癌(HCC)行肝切除术后标准残肝体积(SRLV)与肝功能代偿不全的关系.方法 67例行肝切除的HCC患者,测定下列参数:全肝体积(TLV)、切除肝体积、体表面积(BSA)、残肝体积(RLV)和SRLV.对比分析TLV、RLV、SRLV以及年龄、手术时间、术中出血量等与术后发生肝功能失代偿的关系,并确定预防肝功能失代偿的SRLV安全临界值.结果 根据术后肝功能情况将患者分为两组:术后肝功能轻度失代偿(A组)52例,中、重度肝功能失代偿(B组)15例(中度12例,重度3例,因后者例数过少,故两者合并进行统计分析).分析显示,A、B两组间TLV、手术时间、术中出血量以及年龄无明显差异(P＞0.05)；而RLV、SRLV差异有统计学意义(P＜0.05).其中A组SRLV均值为(562±89)ml/m2、B组为(410±87)ml/m2 (P＜0.01).ROC曲线分析计算SRLV的安全临界值为438ml/m2.随机选取60例行肝切除术的HCC患者,进一步分析显示SRLV≤438 ml/m2患者与SRLV＞ 438 ml/m2患者术后肝功能中、重度失代偿率分别为92.3％和8.5％(P＜0.01).结论 SRLV是预测合并肝硬化HCC术后肝储备功能的良好指标,其安全临界值为438 ml/m2.低于该值术后发生肝功能衰竭的风险较大.
目的 探討閤併肝硬化肝細胞癌(HCC)行肝切除術後標準殘肝體積(SRLV)與肝功能代償不全的關繫.方法 67例行肝切除的HCC患者,測定下列參數:全肝體積(TLV)、切除肝體積、體錶麵積(BSA)、殘肝體積(RLV)和SRLV.對比分析TLV、RLV、SRLV以及年齡、手術時間、術中齣血量等與術後髮生肝功能失代償的關繫,併確定預防肝功能失代償的SRLV安全臨界值.結果 根據術後肝功能情況將患者分為兩組:術後肝功能輕度失代償(A組)52例,中、重度肝功能失代償(B組)15例(中度12例,重度3例,因後者例數過少,故兩者閤併進行統計分析).分析顯示,A、B兩組間TLV、手術時間、術中齣血量以及年齡無明顯差異(P＞0.05)；而RLV、SRLV差異有統計學意義(P＜0.05).其中A組SRLV均值為(562±89)ml/m2、B組為(410±87)ml/m2 (P＜0.01).ROC麯線分析計算SRLV的安全臨界值為438ml/m2.隨機選取60例行肝切除術的HCC患者,進一步分析顯示SRLV≤438 ml/m2患者與SRLV＞ 438 ml/m2患者術後肝功能中、重度失代償率分彆為92.3％和8.5％(P＜0.01).結論 SRLV是預測閤併肝硬化HCC術後肝儲備功能的良好指標,其安全臨界值為438 ml/m2.低于該值術後髮生肝功能衰竭的風險較大.
목적 탐토합병간경화간세포암(HCC)행간절제술후표준잔간체적(SRLV)여간공능대상불전적관계.방법 67례행간절제적HCC환자,측정하렬삼수:전간체적(TLV)、절제간체적、체표면적(BSA)、잔간체적(RLV)화SRLV.대비분석TLV、RLV、SRLV이급년령、수술시간、술중출혈량등여술후발생간공능실대상적관계,병학정예방간공능실대상적SRLV안전림계치.결과 근거술후간공능정황장환자분위량조:술후간공능경도실대상(A조)52례,중、중도간공능실대상(B조)15례(중도12례,중도3례,인후자례수과소,고량자합병진행통계분석).분석현시,A、B량조간TLV、수술시간、술중출혈량이급년령무명현차이(P＞0.05)；이RLV、SRLV차이유통계학의의(P＜0.05).기중A조SRLV균치위(562±89)ml/m2、B조위(410±87)ml/m2 (P＜0.01).ROC곡선분석계산SRLV적안전림계치위438ml/m2.수궤선취60례행간절제술적HCC환자,진일보분석현시SRLV≤438 ml/m2환자여SRLV＞ 438 ml/m2환자술후간공능중、중도실대상솔분별위92.3％화8.5％(P＜0.01).결론 SRLV시예측합병간경화HCC술후간저비공능적량호지표,기안전림계치위438 ml/m2.저우해치술후발생간공능쇠갈적풍험교대.
Objective To investigate the effect of standard remnant liver volume (SRLV) on liver insufficiency after hepatectomy in cirrhotic patients with hepatocellular carcinoma (HCC).Methods Sixty-seven HCC patients with liver cirrhosis were involved in this study.The following parameters were obtained in all cases:total liver volume (TLV),resected liver volume by surgery,body surface area (BSA),remnant liver volume (RLV)and SRLV.Compared analysis of relationship between liver insufficient and the parameters as well as the age of patients,duration of operation and blood lose etc.was carried out,in order to establish the security threshold of SRLV.Results According to the postoperative liver function,the patients were divided into 2 groups:Group A,52cases with mild liver dysfunction; Group B,15cases among them 12 with moderate and 3 with severe liver insufficiency.Statistical analysis showed that the difference of TLV,duration of operation,intra-operative blood lose and age between Group A and B were insignificant(P＞0.05).However,that of RLV and SRLV were significant(P＜0.05).The average SRLV in Group A was 562±89 ml/m2 and 410±87 ml/m2 in Group B (P＜＜0.01).The security threshold of SRLV was 438 ml/m2 calculated by receiver operating characteristic (ROC)in our patients.Then randomly selected sixty HCC patients,the incidences of moderate and severe liver insufficiency postoperative in the SRLV≤438 ml/m2 and SRLV＞438 ml/m2 patients were 92.3％and8.5％ (P＜0.01).Conclusions It is suggested from our present study that SRLV is a good predictor for post-operative liver function reserve in patients with cirrhotic HCC.Its security threshold is 438 ml/m2,and the risk of occurring hepatic failure will be high postoperatively when patient,s SRLV is less than this value.
