A clinical study of standard remnant liver volume in predicting post-hepatectomy liver failure in patients with hepatocellular carcinoma after hemihepatectomy of cirrhotic liver
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摘要:
目的 探讨肝细胞癌（hepatocellular carcinoma，HCC）合并肝硬化患者肝切术标准残肝体积（the standard remnant liver vol-ume，SRLV）的安全临界值及其评估术后肝功能衰竭（post-hepatectomy liver failure，PHLF）的效能。 方法 回顾性分析广西医科大学附属肿瘤医院2013年9月~2016年8月共181例半肝切除术HCC患者临床资料，术前测定肝脏总体积、肿瘤体积、残肝体积、切除的肝体积。术中排水法测定切除标本的体积。按照“50-50标准”分成肝衰竭组（22例）与无肝衰竭组（159例），分析发生PHLF的相关因素，统计分析肝硬化亚组SRLV的临界值及其预测PHLF效能，并回顾性分析肝硬化患者的CT分级资料。 结果 术后共发生PHLF 22例，PHLF相关死亡1例。多因素分析显示术前胆红素水平及SRLV是发生PHLF的危险因素。按照肝硬化病理进行亚组分析，肝硬化组102例（Ⅰ、Ⅱ级肝硬化84例，Ⅲ级肝硬化18例，无Ⅳ级肝硬化），18例发生PHLF，PHLF相关死亡1例。HCC合并肝硬化行半肝切除发生PHLF的SRLV临界值为340 mL/m2（灵敏度94.4%，特异度74.7%，曲线下面积0.861，P＜0.01）。 结论 SRLV≤340 mL/m2的HCC合并肝硬化患者在行半肝切除术后，发生PHLF的风险增高。 Abstract:Objective To explore the correlation between standard remnant liver volume (SRLV) and post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) and cirrhotic livers. Methods In total, 181 patients who underwent hemihepatectomy in Affiliated Tumor Hospital of Guangxi Medical University from September 2013 to August 2016 were enrolled in the study. Total liver, tumor, remnant liver, and resected liver volumes were measured using the Myrian liver surgical planning system before surgery. Intraoperative resected liver volume (including resected normal liver and tumor volumes) were collected using the drainage method. The patients were divided into the PHLF (22 cases) and non-PHLF groups (159 cases) according to whether PHLF occurred based on the "50/50" criteria. The risk factors of PHLF were then explored. The cut-off of SRLV and efficiency of predicting PHLF were analyzed in the subgroup of patients with cirrhotic livers. The grade of liver cirrhosis was retrospectively analyzed using helical computed tomography (CT). Results Twenty-two of the 181 patients developed PHLF and one died of it. Preoperative total bilirubin levels and SRLV were identified as independent factors for predicting PHLF using a Logistic regression model. In total, 102 patients with cirrhotic livers were selected in subgroup analysis based on postoperative cirrhotic pathology. Eighteen patients developed PHLF and one died of PHLF in the subgroup. Using receiver-operating characteristic (ROC) curve analysis, 340 mL/m2 was the cut-off of SRLV for patients with HCC and cirrhotic livers (area under the curve: 0.861, P < 0.01; sensitivity and specialty rates were 94.4% and 74.7%, respectively). Eighty-four cases were of grade Ⅰ or Ⅱ cirrhosis, 18 cases were of grade Ⅲ cirrhosis, and there were no cases of grade Ⅳ cirrhosis based on retrospective analysis using helical CT. Conclusions Patients with cirrhotic livers with an anticipated SRLV of ≤340 mL/m2 after hepatic resection are at increased risk for PHLF after emihepatectomy. -
表 1 两组各项基线资料比较（x±s，n/n）
表 2 肝衰竭相关因素的logistic回归多因素分析
表 3 肝硬化程度CT分级 n（%）
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