【摘要】：目的:評估比較殘肝分?jǐn)?shù)(%RLV)、殘肝體積/標(biāo)準(zhǔn)肝體積(RLV/SLV)、殘肝體積/體重比率(RLV/BW)及標(biāo)準(zhǔn)殘肝體積(SRLV)預(yù)測半肝切除術(shù)后發(fā)生肝功能衰竭(PHLF)的效能。方法:對181例乙肝病毒相關(guān)性肝細(xì)胞癌(HCC)病人術(shù)前采用Myrian-Liver手術(shù)規(guī)劃系統(tǒng)測模擬半肝切除并測定總功能性肝體積、腫瘤體積、殘肝體積、切除的肝體積。術(shù)中按照標(biāo)準(zhǔn)半肝切除,并排水法測定切除肝臟與腫瘤的總體積。按照50-50標(biāo)準(zhǔn)和國際肝臟外科小組(ISGLS)肝衰竭標(biāo)準(zhǔn)分別分組,分析術(shù)后發(fā)生PHLF的風(fēng)險因素。ROC曲線分析比較%RLV、RLV/SLV、RLV/BW及SRLV預(yù)測PHLF的效能。根據(jù)預(yù)測PHLF的優(yōu)勢指標(biāo)的截點值分組,比較兩組間并發(fā)癥發(fā)生率。結(jié)果:根據(jù)多因素分析結(jié)果,50-50標(biāo)準(zhǔn)分組顯示肝硬化(HR:0.002,95%CI:0-0.244,P=0.012)、RLV/SLV(HR:1.16×10205,95%CI:6.007×1028-8.543×10428,P=0.023)、RLV/BW(HR:2.58×1030,95%CI:9.546×107-6.971×1052,P=0.008)及SRLV(HR:0,95%CI:0-0.010,P=0.022)是術(shù)后發(fā)生PHLF的危險因素(P0.05)。根據(jù)ISGLS肝功能衰竭標(biāo)準(zhǔn)分組,多因素分析結(jié)果顯示術(shù)中出血量(HR:1.001,95%CI:1.000-1.002,P=0.004)及SRLV(HR:0.985,95%CI:0.971-0.999,P=0.033)是發(fā)生PHLF的危險因素(P0.05)。ROC曲線比較分析,50-50標(biāo)準(zhǔn)分組中,RLV/SLV、SRLV分別比較%RLV、RLV/BW具都有統(tǒng)計學(xué)意義(P0.05)。RLV/SLV與SRLV間比較無統(tǒng)計學(xué)差異(P0.05)。ROC曲線下面積(AUC)最大為SRLV和RLV/SLV(均為0.903)。SRLV發(fā)生PHLF的截點值為340ml/m~2,RLV/SLV截點值48%,靈敏度均為100%,特異度均為72.3%。ISGLS標(biāo)準(zhǔn)分組中,ROC曲線比較分析顯示SRLV與RLV/SLV、RLV/BW比較有統(tǒng)計學(xué)差異(P0.05),%RLV與RLV/SLV、RLV/BW、SRLV比較均無統(tǒng)計學(xué)意義(P0.05)。AUC最大者為SRLV(0.776),截點值340ml/m~2,靈敏度64%,特異度88.7%,P0.01)。SRLV340ml/m~2組病人術(shù)后無并發(fā)癥38例(32.8%),輕度并發(fā)癥65例(56%),重度并發(fā)癥13例(11.2%);SRLV≤340 ml/m~2組術(shù)后無并發(fā)癥1例(1.5%),輕度并發(fā)癥40例(61.5%),重度并發(fā)癥23例(35.4%),死亡1例(1.5%),差異有統(tǒng)計學(xué)意義(P0.01)。結(jié)論:%RLV、RLV/SLV、RLV/BW及SRLV均為評估殘肝體積的有效指標(biāo)。對比研究,SRLV較%RLV、RLV/SLV、RLV/BW在評估術(shù)后發(fā)生PHLF具備更高敏感性、特異性,更穩(wěn)定的特點。當(dāng)SRLV≤340ml/m~2時,乙肝病人半肝切除術(shù)后發(fā)生PHLF的風(fēng)險增加,且增加術(shù)后重度并發(fā)癥發(fā)生的風(fēng)險。
[Abstract]:Objective: to evaluate the efficacy of residual liver fraction (RLV), residual liver volume / standard liver volume (RLV/SLV), residual liver volume / body weight ratio (RLV/BW) and standard residual liver volume (SRLV) in predicting hepatic failure (PHLF) after hemihepatectomy. Methods: the total functional liver volume, tumor volume, residual liver volume and liver volume were measured by Myrian-Liver operation planning system in 181 patients with hepatitis B virus associated hepatocellular carcinoma (HCC) before operation. The total volume of liver and tumor was measured by standard hemihepatectomy and drainage method. According to the 50-50 standard and the (ISGLS) liver failure standard of the international group of liver surgery, the risk factors of PHLF after operation were analyzed. The ROC curve was used to analyze and compare the RLVR / SLV / BW and SRLV in predicting PHLF. The incidence of complications was compared between the two groups according to the cut-off points of the predominance index of PHLF. Results: according to the multivariate analysis results, the RLVP / SLV (HR:1.16 脳 10205CI6.007 脳 1028-8.543 脳 10428P0.023) and SRLV (HR:2.58 脳 103095CI9.546 脳 107-6.971 脳 1052P0.008) and SRLV (HR095) were the risk factors for the occurrence of PHLF after operation (P 0.05). According to ISGLS criteria for liver failure, Multivariate analysis showed that intraoperative bleeding volume (HR: 1.001 / 95CI: 1.000-1.002P0.004) and SRLV (HR0.985C95CI0.971-0.999P0.033) were the risk factors for the occurrence of PHLF (P0.05). The maximum value of (AUC) is SRLV and RLV/SLV (both 0.903). The cut-off point of PHLF is 340 ml / r / v, the sensitivity is 100 and the specificity is 100 in 72.3%.ISGLS standard group. The comparison between SRLV and RLVSLV / RLV / BW shows that there is no statistical difference between RLV / RLVR / RLV / RLV / RLVR / W / BW (P0.05). The largest value of AUC was SRLV (0.776), with a cut-off value of 340 ml / m ~ (2), a sensitivity of 64 and a specificity of 88.7ml / m ~ (0.01). There were 38 cases (32.8%) in the SRLV340ml / mmg group, 65 cases (56%) in the mild complication group, 13 cases (11.2%) in the LV 鈮，

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