Li Yi-Ming, Lv Fan, Xu Xin, Ji Hong, Gao Wen-Tao, Lei Tuan-Jie, Ren Gui-Bing, Bai Zhi-Lan, Li Qiang
General Surgery Department, the 2nd Hospital of Xi'an Jiaotong University, Xi'an 710004, ShaanXi Province, China.
World J Gastroenterol. 2003 Sep;9(9):2092-5. doi: 10.3748/wjg.v9.i9.2092.
Our research attempted to evaluate the overall functional reserve of cirrhotic liver by combination of hepatic functional blood flow, liver volume, and Child-Pugh's classification, and to discuss its value of clinical application.
Ninety two patients with portal hypertension due to hepatic cirrhosis were investigated. All had a history of haematemesis and hematochezia, esophageal and gastric fundus varices, splenomegaly and hypersplenia. A 2-year follow-up was routinely performed and no one was lost. Twenty two healthy volunteers were used as control group. Blood and urine samples were collected 4 times before and after intravenous D-sorbitol infusion. The hepatic clearance (CL(H)) of D-sorbitol was then calculated according to enzymatic spectrophotometric method while the total blood flow (Q(TOTAL)) and intrahepatic shunt (R(INS)) were detected by multicolor Doppler ultrasound, and the liver volume was measured by spiral CT. Data were estimated by t-test, variance calculation and chi-squared test. The relationships between all these parameters and different groups were investigated according to Child-Pugh classification and postoperative complications respectively.
Steady blood concentration was achieved 120 mins after D-sorbitol intravenous infusion, which was (0.358+/-0.064) mmol x L(-1) in cirrhotic group and (0.189+/-0.05) mmol x L(-1) in control group (P<0.01). CL(H) =(812.7+/-112.4) ml x min(-1), Q(TOTAL) =(1280.6+/-131.4) ml x min(-1), and R(INS) =(36.54+/-10.65) % in cirrhotic group and CL(H)=(1248.3+/-210.5) ml x min(-1), Q(TOTAL)=(1362.4+/-126.9) ml x min(-1), and R(INS)=(8.37+/-3.32) % in control group (P<0.01). The liver volume of cirrhotic group was 1057+/-249 cm(3), 851+/-148 cm(3) and 663+/-77 cm(3) in Child A, B and C group respectively with significant difference (P<0.001). The average volume of cirrhotic liver in Child B, C group was significantly reduced in comparison with that in control group (P<0.001). The patient, whose liver volume decreased by 40 % with the CLH below 600 ml x min(-1), would have a higher incidence of postoperative complications. There was no strict correspondent relationship between CL(H), liver volume and Child-Pugh's classification.
The hepatic clearance of D-sorbitol, CT measured liver volume can be reliably used for the evaluation of hepatic functional blood flow and liver metabolic volume. Combined with the Child-Pugh's classification, it could be very useful for further understanding the liver functional reserve, therefore help determine reasonable therapeutic plan, choose surgical procedures and operating time.
本研究试图通过肝功能血流量、肝脏体积及Child-Pugh分级相结合来评估肝硬化肝脏的整体功能储备，并探讨其临床应用价值。
对92例肝硬化门静脉高压患者进行研究。所有患者均有呕血、便血史，食管及胃底静脉曲张，脾肿大及脾功能亢进。常规进行2年随访，无失访病例。选取22名健康志愿者作为对照组。静脉注射D-山梨醇前后各采集4次血样和尿样。然后根据酶分光光度法计算D-山梨醇的肝清除率（CL(H)），用多色多普勒超声检测总血流量（Q(TOTAL)）和肝内分流（R(INS)），用螺旋CT测量肝脏体积。数据采用t检验、方差计算和卡方检验进行评估。分别根据Child-Pugh分级和术后并发症研究所有这些参数与不同组之间的关系。
D-山梨醇静脉输注120分钟后达到稳定血药浓度，肝硬化组为(0.358±0.064) mmol·L(-1)，对照组为(0.189±0.05) mmol·L(-1)（P<0.01）。肝硬化组CL(H)=(812.7±112.4) ml·min(-1)，Q(TOTAL)=(1280.6±131.4) ml·min(-1)，R(INS)=(36.54±10.65)%；对照组CL(H)=(1248.3±210.5) ml·min(-1)，Q(TOTAL)=(1362.4±126.9) ml·min(-1)，R(INS)=(8.37±3.32)%（P<0.01）。肝硬化组Child A、B、C级患者的肝脏体积分别为1057±249 cm(3)、851±148 cm(3)和663±77 cm(3)，差异有统计学意义（P<0.001）。Child B、C级肝硬化患者肝脏的平均体积与对照组相比显著减小（P<0.001）。肝脏体积减少40%且CLH低于600 ml·min(-1)的患者术后并发症发生率较高。CL(H)、肝脏体积与Child-Pugh分级之间无严格的对应关系。
D-山梨醇的肝清除率、CT测量的肝脏体积可可靠地用于评估肝功能血流量和肝脏代谢容积。结合Child-Pugh分级，对于进一步了解肝脏功能储备、从而帮助确定合理的治疗方案、选择手术方式和手术时机非常有用。
