不同残肝体积评估指标预测术后肝功能衰竭效能及比较分析

发布时间：2018-08-09 20:51

【摘要】：目的:评估比较残肝分数(%RLV)、残肝体积/标准肝体积(RLV/SLV)、残肝体积/体重比率(RLV/BW)及标准残肝体积(SRLV)预测半肝切除术后发生肝功能衰竭(PHLF)的效能。方法:对181例乙肝病毒相关性肝细胞癌(HCC)病人术前采用Myrian-Liver手术规划系统测模拟半肝切除并测定总功能性肝体积、肿瘤体积、残肝体积、切除的肝体积。术中按照标准半肝切除,并排水法测定切除肝脏与肿瘤的总体积。按照50-50标准和国际肝脏外科小组(ISGLS)肝衰竭标准分别分组,分析术后发生PHLF的风险因素。ROC曲线分析比较%RLV、RLV/SLV、RLV/BW及SRLV预测PHLF的效能。根据预测PHLF的优势指标的截点值分组,比较两组间并发症发生率。结果:根据多因素分析结果,50-50标准分组显示肝硬化(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)是术后发生PHLF的危险因素(P0.05)。根据ISGLS肝功能衰竭标准分组,多因素分析结果显示术中出血量(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)是发生PHLF的危险因素(P0.05)。ROC曲线比较分析,50-50标准分组中,RLV/SLV、SRLV分别比较%RLV、RLV/BW具都有统计学意义(P0.05)。RLV/SLV与SRLV间比较无统计学差异(P0.05)。ROC曲线下面积(AUC)最大为SRLV和RLV/SLV(均为0.903)。SRLV发生PHLF的截点值为340ml/m~2,RLV/SLV截点值48%,灵敏度均为100%,特异度均为72.3%。ISGLS标准分组中,ROC曲线比较分析显示SRLV与RLV/SLV、RLV/BW比较有统计学差异(P0.05),%RLV与RLV/SLV、RLV/BW、SRLV比较均无统计学意义(P0.05)。AUC最大者为SRLV(0.776),截点值340ml/m~2,灵敏度64%,特异度88.7%,P0.01)。SRLV340ml/m~2组病人术后无并发症38例(32.8%),轻度并发症65例(56%),重度并发症13例(11.2%);SRLV≤340 ml/m~2组术后无并发症1例(1.5%),轻度并发症40例(61.5%),重度并发症23例(35.4%),死亡1例(1.5%),差异有统计学意义(P0.01)。结论:%RLV、RLV/SLV、RLV/BW及SRLV均为评估残肝体积的有效指标。对比研究,SRLV较%RLV、RLV/SLV、RLV/BW在评估术后发生PHLF具备更高敏感性、特异性,更稳定的特点。当SRLV≤340ml/m~2时,乙肝病人半肝切除术后发生PHLF的风险增加,且增加术后重度并发症发生的风险。
[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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