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[目的]探讨标准残肝体积(SRLV)大小及肝纤维化程度与原发性肝癌切除术后发生肝功能代偿不全间的关系。[方法]对因肝癌行肝切除术的104例病例进行研究。残肝体积=全肝体积-切除肝脏体积;SRLV=残肝体积/体表面积;根据声脉冲辐射力成像(acoustic radiation force impulse,ARFI)评分将所有病例分为A组(中、重度肝纤维化组)和B组(正常或轻度肝纤维化组)。通过受试者工作特征曲线(ROC)分析预防发生肝功能代偿不全的SRLV安全临界值。并将术后发生肝功能中度代偿不全患者的术前ARFI评分与术后SRLV进行直线回归分析。[结果]A组病例术后发生肝功能轻度代偿不全、中度代偿不全及重度代偿不全分别为53例、22例、4例。在A组病例中,肝功能中、重度代偿不全发生率为32.9%,(26/79),肝功能轻度代偿不全患者和中、重度代偿不全患者的SRLV[(605.69±118.98)ml/m~2vs(470.81±62.59)ml/m~2]比较具有显著差异(P<0.05)。ROC曲线分析提示发生肝功能中、重度代偿不全的SRLV的临界值为503ml/m~2。B组病例数少,不作统计学分析。将术后发生肝功能中度代偿不全患者的术前ARFI评分及术后SRLV进行直线回归分析,显示呈正相关(R=0.719,P<0.01),其回归方程为:SRLV(ml/m~2)=149.6×ARFI评分(m/s)+194.1。[结论 ]联合SRLV及肝纤维化程度测定对原发性肝癌术前安全切肝量评估有重要指导价值,对伴中、重度肝纤维化患者安全SRLV临界值为503ml/m~2。
[Objective] To investigate the relationship between standard residual volume of liver (SRLV) and degree of liver fibrosis and hepatic decompensation after primary hepatectomy. [Method] A total of 104 cases of hepatectomy due to liver cancer were studied. Residual liver volume = total liver volume-excised liver volume; SRLV = residual liver volume / body surface area; all patients were divided into group A (moderate and severe liver fibrosis) according to acoustic radiation force impulse (ARFI) Group) and group B (normal or mild liver fibrosis group). The SRLV safety cut-off for prevention of hepatic decompensation was analyzed by receiver operating characteristic curve (ROC). The preoperative ARFI score and postoperative SRLV in patients with moderate decompensation of liver function were analyzed by linear regression. [Results] A group of patients with mild liver failure occurred after partial remission, moderate decompensation and severe decompensation were 53 cases, 22 cases, 4 cases. In group A, the incidence of severe decompensation was 32.9% (26/79) in patients with liver dysfunction, SRLV [(605.69 ± 118.98)) in patients with mild decompensation of liver function and in moderately and severely compensated patients, ml / m ~ 2vs (470.81 ± 62.59) ml / m ~ 2 compared with the significant difference (P <0.05). The ROC curve analysis suggested that the critical value of SRLV for severe decompensation in liver function was 503ml / m ~ 2. B group of small number of cases, not for statistical analysis. The linear regression analysis of preoperative ARFI score and postoperative SRLV showed a positive correlation (R = 0.719, P <0.01). The regression equation was SRLV (ml / m ~ 2) = 149.6 × ARFI score (m / s) + 194.1. [Conclusion] Combined SRLV and the degree of hepatic fibrosis have an important guiding value in the evaluation of preoperative hepatectomy for liver cancer. The critical value of safety SRLV for patients with moderate and severe hepatic fibrosis is 503ml / m ~ 2.