Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
HPB (Oxford). 2013 Sep;15(9):732-9. doi: 10.1111/hpb.12042. Epub 2013 Feb 1.
The aim of the present study was to determine the utility of computed tomography (CT) and magnetic resonance imaging (MRI) anatomic mapping in the detection of biliary and vascular anomalies prior to a living liver donor (LLD) operation.
A retrospective study of all LLD patient charts, operative and radiology reports from 1 January 2002 to 1 January 2012 was conducted. Primary post-operative outcomes assessed included mortality, re-operation, readmission and need for endoscopic or percutaneous intervention. Sensitivity and specificity of MR and CT pre-operative screening was calculated against the gold standard of intra-operative findings.
A total of 34 donors had an average age of 38 years (range: 22-58) with a body mass index (BMI) of 25.6 kg/m(2) (range: 19.8-32.5) and a length of stay (LOS) of 10.1 days (range: 5-41). There were no donor mortalities. Sensitivity and specificity of CT was 70.0% and 91.3%, and of MRI screening 23.1% and 100.0%, respectively. Patients with inaccurate pre-operative CT or MRI did not have an increased risk of complications.
Even although it was specific, pre-operative MR screening missed up to 77.0% of biliary anomalies. An impeccable surgical technique remains the key in preventing biliary complications of a living donor hepatectomy where pre-operative MRI screening is false.
本研究旨在确定 CT 和 MRI 解剖成像在活体肝供者（LLD）手术前检测胆道和血管异常的作用。
对 2002 年 1 月 1 日至 2012 年 1 月 1 日所有 LLD 患者的病历、手术和放射学报告进行回顾性研究。主要术后评估结果包括死亡率、再次手术、再入院以及需要内镜或经皮介入治疗。MR 和 CT 术前筛查的敏感性和特异性与术中发现的金标准进行比较。
共有 34 名供者，平均年龄 38 岁（范围：22-58 岁），体重指数（BMI）为 25.6kg/m²（范围：19.8-32.5），住院时间（LOS）为 10.1 天（范围：5-41）。无供者死亡。CT 的敏感性和特异性分别为 70.0%和 91.3%，MRI 筛查的敏感性和特异性分别为 23.1%和 100.0%。术前 CT 或 MRI 不准确的患者并发症风险并未增加。
尽管 MRI 术前筛查具有特异性，但仍可能漏诊高达 77.0%的胆道异常。在术前 MRI 筛查有误的情况下，精湛的手术技术仍然是预防活体供肝切除术胆道并发症的关键。
