摘要目的 以术前脾脏体积为参照,探讨功能性残余肝脏体积与脾脏体积比(FreLSVR)对患者术后肝功能不全以及肝功能恢复的影响.方法 对2016年1月至2017年10月共计74例接受精准肝脏部分切除术患者的临床资料进行分析.通过三维软件对术前腹部CT影像资料进行三维重建,测量并计算肿瘤体积、预估功能性残肝体积、脾脏体积以及FreLSVR等观察指标.记录患者术前及术后肝功能、凝血功能等检验验指标以及手术时间、术中出血量、术后每日腹水量及并发症发生情况,并予分析比较.结果 肝功能不全组患者16例(21.6％),无肝功能不全组患者58例(78.4％).单因素分析结果显示标准化残肝体积比例(P=＜0.05)、FreLSVR (P=＜0.05)和术前AST值(P=＜0.05)与术后肝功能不全发生相关.多因素回归分析结果显示FreLSVR(OR=0.535,95％CI:0.305～0.936,P=＜0.05)是术后发生肝功能不全的独立影响因素.根据ROC曲线及约登指数,FreLSVR与术后肝功能不全相关的最佳截断值为2.56(AUC=0.755,敏感度81.1％,特异度71.7％).依据截断值将患者重新分组,与FreLSVR＞2.56组(53例)比较,FreLSVR≤2.56组(21例)术后INR最高值较高(1.46±0.19比1.29±0.29,t=-2.405,P＜0.05)并且术后1周和2周内平均每日腹水量较多[分别为188.0(79.2～375.1)ml比96.0(46.5～179.3)ml,P＜0.05和207.2(125.6～827.1)ml比71.8(14.0～179.8)ml,P＜0.05],差异有统计学意义.结论 FreLSVR与患者术后肝功能不全发生有明显相关性,可为今后精准肝脏切除手术安全性提供指导.

abstractsObjective Toidentify factors contributing to posthepatectomy liver dysfunction (PHLD),focusing on the Functional remnant liver volume to spleen volume ratio (FreLSVR).Methods The clinical data of 74 patients undergoing precise liver resection from January 2016 to October 2017 were retrospectively analyzed.IQQA liver system was used to reconstruct the liver and spleen 3D image by using patients' preoperative abdominal CT image data.Tumor volume,3D estimated functional residual liver volume,spleen volume and FreLSVR were measured and calculated.Preoperative and postoperative liver function test,blood coagulation function test,operation time,intraoperative blood loss,and the volume of daily postoperative abdominal drainage were recorded.Correlations between multiple parameters and PHLD were analyzed.Results PHLD occurred in 16 (21.6％).Single factor analysis revealed that the standardized residual liver volume ratio (P＜0.05),FreLSVR (P＜0.05) and preoperative AST value (P＜0.05) were correlated with postoperative hepatic insufficiency.Multivariate regression analysis showed that FreLSVR (OR=0.535,95％CI=0.305～0.936,P＜0.05) was the only independent factor of PHLD.In the ROC curve analysis for FreLSVR,a cut-off value of 2.56 (AUC=0.824,Sensitivity 81.1％,specificity 71.7％.) was the appropriate value for predicting the risk of PHLD according to Youden index.Then the patients were regrouped according to this cut-off value.Compared with the FreLSVR＞2.56 group (53 cases),the highest postoperative INR value (1.46± 0.19 to 1.29± 0.29,t=-2.405,P＜0.05) was higher that of FreLSVR≤2.56 group,and the amount of average daily abdominal drainage in one and two weeks after operation was higher,(188.0(79.2 ～ 375.1)ml to 96.0(46.5 ～ 179.3)ml,P＜0.05) and (207.2(125.6 ～ 827.1)ml to71.8(14.0 ～ 179.8) ml,P＜0.05),respectively.Conclusion FreLSVR has significant correlation with postoperative hepatic dysfunction,and provides guidance for the safety of liver resection in the future.