Lemke A-J, Brinkmann M J, Pascher A, Steinmüller T, Settmacher U, Neuhaus P, Felix R
Universitätsklinikum Charité, Campus Virchow-Klinikum, Klinik für Strahlenheilkunde, Berlin.
Rofo. 2003 Sep;175(9):1232-8. doi: 10.1055/s-2003-41938.
Due to the shortage of cadaver donors, living related liver donation (LRLD) has emerged as an alternative to cadaver donation. The expected graft weight is one of the main determinants for donor selection. This study investigates the accuracy of preoperatively performed CT-volumetry to predict the actual weight of the right liver lobe graft.
In a prospective study the weight of the right hepatic lobe was calculated by volumetric analysis based on CT in 33 patients (21 females, 12 males, mean age 42.1 years, median age 41 years) prior to living related liver donation. Graft weight was calculated as the product of CT-based graft volume and 1.00 g/ml (the approximated density of healthy liver parenchyma). The calculated weight was compared with the intraoperatively measured weight of the harvested right hepatic lobe. The difference was used to determine a correction factor for estimating the actual graft weight.
Based on the assumption of a parenchymal density of 1.00 g/ml, the preoperatively estimated graft weight (mean 980 g +/- 168 g) deviated +33 % from the intraoperatively measured right hepatic lobe weight (mean 749 g +/- 170 g). By reducing the preoperatively predicted weight of the right hepatic lobe with a correction factor of 0.75, the actual graft weight can be calculated.
Preoperative estimation of the weight of the right hepatic lobe based on CT of living related liver donors predicts the weight of the right lobe graft with sufficient accuracy by applying a single correction factor. Intraoperative fluid loss (i.e., blood, bile) from the harvested liver as well as variations in parenchymal density may contribute to the observed preoperative overestimation of the actual graft volume by CT-based volumetry.
由于尸体供体短缺，活体亲属肝移植（LRLD）已成为尸体捐赠的一种替代方式。预期的移植肝重量是供体选择的主要决定因素之一。本研究调查术前CT容积测量预测右肝叶移植实际重量的准确性。
在一项前瞻性研究中，对33例活体亲属肝移植患者（21例女性，12例男性，平均年龄42.1岁，中位年龄41岁）术前基于CT通过容积分析计算右肝叶重量。移植肝重量通过基于CT的移植肝体积乘以1.00 g/ml（健康肝实质的近似密度）来计算。将计算出的重量与术中测量的切除右肝叶重量进行比较。该差异用于确定估计实际移植肝重量的校正因子。
基于实质密度为1.00 g/ml的假设，术前估计的移植肝重量（平均980 g±168 g）与术中测量的右肝叶重量（平均749 g±170 g）相差+33%。通过用0.75的校正因子减少术前预测的右肝叶重量，可以计算出实际移植肝重量。
通过应用单一校正因子，基于活体亲属肝供体CT的右肝叶重量术前估计能够足够准确地预测右叶移植肝的重量。术中切除肝脏的液体丢失（即血液、胆汁）以及实质密度的变化可能导致基于CT的容积测量术前对实际移植肝体积的高估。
