部分肝切除术后 6 个月时的早期肝再生指数和再生完整性。

Early hepatic regeneration index and completeness of regeneration at 6 months after partial hepatectomy.

机构信息

Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.

出版信息

Br J Surg. 2012 Aug;99(8):1113-9. doi: 10.1002/bjs.8807. Epub 2012 Jun 14.

DOI:10.1002/bjs.8807

PMID:22696005

Abstract

BACKGROUND

The liver is known to regenerate following partial hepatectomy (PH), but little is known about the timing and completeness of regeneration relative to the resected volume. This study examined whether liver volume regeneration following PH and its completeness 6 months after surgery is related to the resected volume.

METHODS

A consecutive series of patients undergoing PH were included. All patients underwent preoperative computed tomography (CT) before and 7 days after surgery. Additional scans were performed 6 months after operation. Preoperative total liver volume (TLV), resected volume, future liver remnant (FLR) and liver remnant (LR) volumes were measured on CT images by freehand drawing of regions of interest in the portal venous phase on 2-mm thick slices. Regeneration indices were calculated at 7 days (RI(early)) and 6 months (RI(total)) using the formula 100 × (LR volume-FLR volume)/FLR volume. Patients were classified into five groups based on resected volume as a percentage of TLV: 0-19, 20-39, 40-59, 60-69 and at least 70 per cent in groups 1-5 respectively.

RESULTS

Ninety-one patients were enrolled. RI(early) varied from 11 to 66 per cent in groups 1-5 (P < 0·001). RI(early) did not increase linearly with increasing resection volume and a plateau was seen from group 3 and above. In contrast, RI(total) was related linearly to resected volume; values ranged from 21 to 233 per cent in groups 1-5 (P < 0·001). At 7 days, LR volume represented 97, 87, 70, 58 and 41 per cent of TLV in groups 1-5. At 6 months, respective values were 102, 99, 87, 82 and 91 per cent.

CONCLUSION

Early postoperative liver volume regeneration was not related linearly to resected volume. At 6 months after surgery, RI was related linearly to resected volume, but LRs had not yet regenerated to preoperative TLV.

摘要

背景

已知肝脏在部分肝切除（PH）后会再生，但对于相对于切除体积的再生时间和完整性知之甚少。本研究检查了 PH 后肝脏体积的再生及其在手术后 6 个月的完整性是否与切除体积有关。

方法

纳入了一系列连续接受 PH 的患者。所有患者在术前和术后 7 天均进行了术前计算机断层扫描（CT）。在术后 6 个月进行了额外的扫描。在门静脉期对 2 毫米厚的切片进行自由手绘感兴趣区域，在 CT 图像上测量术前总肝体积（TLV）、切除体积、未来肝残留（FLR）和肝残留（LR）体积。使用公式 100×（LR 体积-FLR 体积）/FLR 体积，在第 7 天（RI（早期））和第 6 个月（RI（总））计算再生指数。根据切除体积占 TLV 的百分比将患者分为五组：分别为第 1-5 组的 0-19%、20-39%、40-59%、60-69%和至少 70%。

结果

共纳入 91 例患者。第 1-5 组的 RI（早期）从 11%到 66%不等（P<0·001）。RI（早期）并未随切除体积的增加呈线性增加，从第 3 组及以上可见到一个平台。相比之下，RI（总）与切除体积呈线性相关；第 1-5 组的范围从 21%到 233%不等（P<0·001）。第 7 天，LR 体积在第 1-5 组中分别占 TLV 的 97%、87%、70%、58%和 41%。第 6 个月，相应的值分别为 102%、99%、87%、82%和 91%。