CT灌注成像在术前评估原发性肝癌合并肝纤维化者肝储备功能中的价值初探

doi:10.3877/cma.j.issn.1674-0793.2010.04.015

中华普通外科学文献(电子版) ›› 2010, Vol. 04 ›› Issue (04) : 355 -359. doi: 10.3877/cma.j.issn.1674-0793.2010.04.015

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论著

CT灌注成像在术前评估原发性肝癌合并肝纤维化者肝储备功能中的价值初探

胡剑飞¹^,^†(

), 雷正明², 谢云川³, 付文广²

^1. 610213　双流县第二人民医院肝胆外科
^2. 泸州医学院附属医院肝胆外科
^3. 泸州医学院附属医院CT室

收稿日期:2009-11-23 出版日期:2010-08-01
通信作者: 胡剑飞
基金资助:
四川省卫生厅科研项目(080185)

Preliminary explore the value of CT perfusion imaging for evaluating pre-operative hepatic functional reserve of primary liver cancer complicated with hepatic fibrosis

Jian-fei HU¹^,^†(), Zheng-ming LEI², Yun-chuan XIE³, Wen-guang FU²

^1. Department of Hepatobiliary Surgery, the Second People’s Hospital, Shuangliu 610213, China

Received:2009-11-23 Published:2010-08-01
Corresponding author: Jian-fei HU
About author:
Corresponding auther: HU Jian-fei, Email: hujianfei321@sina.com

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目的

初步探讨CT灌注（CTP）成像术前评估原发性肝癌合并肝纤维化者肝储备功能的价值。

方法

以18例原发性肝癌合并肝纤维化患者为试验组，以10例健康者为对照组。试验组术前行肝脏CTP扫描筛检S₁~S₄期敏感的CTP参数；分析CTP结合Child-Pugh分级、标准残肝体积比（STELV）与患者术后出现肝功能障碍发生的关系。

结果

①术前所有患者均为Child-Pugh A级，肝实质纤维化属S₁~S₄期，CT扫描无明显肝硬化形态学的改变。门静脉灌注量（HPP）、肝动脉灌注量（HAP）、总肝灌注量（TLP）、门静脉灌注指数（PPI）试验组分别为（85.94±6.00）ml·min^-1·100g^-1、（27.89±4.74）ml·min^-1·100g^-1、（113.83±2.39）ml·min^-1·100g^-1、（0.75±0.10）%；对照组分别为（93.5±9.56）ml·min^-1·100g^-1、（25.10±2.85）ml·min^-1·100g^-1、（118.60±7.53）ml·min^-1·100g^-1、（0.78±0.11）%。两组比较，试验组HPP有明显下降，差异有统计学意义；TLP、HAP和PPI差异无统计学意义。②术后在Child-Pugh A级基础上，以术后肝功能障碍出现的有无作为判别结果，以HPP和STELV作为判别指标，经判别分析建立方程：f₁=5.533X₁+375.418X₂-382.957，f₂=5.221X₁+354.685X₂-341.385，Wilks' Lambda值为0.610，P<0.05。

结论

HPP能反映肝纤维化S₁~S₄期肝血流的变化，结合CTP参数和STELV，能建立有意义的判别方程，初步评估原发性肝癌合并肝纤维化者的肝储备功能。

关键词: 原发性肝癌, 肝纤维化, 肝储备功能, CT灌注

Objective

To preliminary explore the value of CT perfusion for evaluating pre-operative hepatic functional reserve of primary liver cancer complicated with hepatic fibrosis.

Methods

The test group included 18 cases of primary liver cancer complicated with hepatic fibrosis of S₁-S₄. The control group included 10 cases of healthy. All patients were given preoperative heptic CT perfusion scan for screening a sensitive parameter of CTP when hepatic parenchyma had fibrosis of S₁-S₄. To analyse relationship of dysfunction and the parameter of CTP combinating Child-Pugh classification and STELV.

Results

Before operation, all patients in the test group were in A geade. The degree of hepatic parenchyma was all in the degree of S₁-S₄. Through preoperative CT scan, obvious change of cirrhosis in shape and profile was not found. The data of HPP, HAP, TLP and PPI were (85.94±6.00) ml·min^-1·100g^-1, (27.89±4.74) ml·min^-1·100g^-1, (113.83±2.39) ml·min^-1·100g^-1 and (0.75±0.10)%. That of the control group were (93.5±9.56) ml·min^-1·100g^-1, (25.10±2.85) ml·min^-1·100g^-1, (118.60±7.53) ml·min^-1·100g^-1 and (0.78±0.11)%. HPP of the test group was significant lower than the control group. TLP, HAP and PPI of the test group were not significant difference comparing with those of the control group. In the base of Child-Pugh A after operation, we put HPP and STELV as discriminant indicators and the emergence of hepatic dysfunction as discriminant result. Two discriminant equations were got: f₁=5.533X₁+375.418X₂-382.957; f₂=5.221X₁+354.685X₂-341.381. Wilks' Lambda value was 0.610, P<0.05.

Conclusions

HPP of CTP parameters can measure the change of blood flow in the degree of S₁-S₄. It can establish a sensible equations that can preliminary assess preoperative hepatic functional reserve of PLC.

Key words: Primary liver cancer, Hepatic fibrosis, Hepatic functional reserve, Computed tomography perfusion

表1 试验组与正常对照组的TLP、HPP、HAP（ml·min^-1·100g^-1）

组别	HPP	HAP	TLP	PPI(%)
肝癌组	85.94±6.00^*	27.89±4.74	113.83±2.39	0.75±0.10
对照组	93.50±9.56	25.10±2.85	118.60±7.53	0.78±0.11
t值	2.578	1.691	1.971	2.013
P值	0.016	1.103	0.077	0.055

表1 试验组与正常对照组的TLP、HPP、HAP（ml·min^-1·100g^-1）

组别	HPP	HAP	TLP	PPI(%)
肝癌组	85.94±6.00^*	27.89±4.74	113.83±2.39	0.75±0.10
对照组	93.50±9.56	25.10±2.85	118.60±7.53	0.78±0.11
t值	2.578	1.691	1.971	2.013
P值	0.016	1.103	0.077	0.055

图1 以HPP和STELR为变量绘制的散点图，'1’表示术后无并发症，'2’表示术后发生并发症

1	吴在德.外科学. 6版.北京：人民卫生出版社，2004: 542-545.
2	Fazakas J, Mándli T, Ther G，et al. Evaluation of liver function for hepatic resection. Transplant Proc，2006，38(3):798-800.
3	Wakabayashi H, Ishimura K, Izuishi K，et al. Evaluation of liver function for hepatic resection for hepatocellular carcinoma in the liver-damaged parenchyma. J Surg Res，2004，116(2):248-252.
4	Herold C, Heinz R, Niedobitek G，et al. Quantitative testing of liver function in relation to fibrosis in patients with chronic hepatitis B and C. Liver，2001，21(4):260-265.
5	Miles KA, Hayball MP, Dixon AK. Functional images of hepatic perfusion obtained with dynamic CT. Radiology，1993，188(2):405-411.
6	Tian JL, Zhang JS. Hepatic perfusion disorder: etipaogenesis and related disease. World J Gastroenterol，2006，12(20):3265-3270.
7	Pandharipande PV, Krinsky GA, Rusinek H，et al. Perfusion imaging of the liver: current chanllenge and future goal. Radiology，2005，234(3):661-673.
8	Guan S, Zhao WD, Zhou KR，et al. CT perfusion at early stage of hepatic diffuse disease.World J Gastroenterol，2005，11(22):3465-3467.
9	马春梅，郭启永，廖勇，等. CT灌注成像在兔肝纤维化模型的研究.中国医学影像技术，2007，23(5):641-644.
10	Yamanka N, Okamoto E, Kuwata K，et al. A multiple regressing equation for prediction of posthepatectomy liver failure. Ann Surg，1984，200(5):658-663.
11	Yamanka N, Okamoto E, Oriyama T. A prediction scoring system to select the surgical treatment of liver cancer. Further refinement based on 10 years of use. Ann Surg，1994，219(4):342-346.
12	袁友红，肖恩华.肝磁共振血流灌注成像及进展.中国医学影像技术，2004，20(1):159-162.
13	连海英，张雪林.磁共振灌注成像在肝硬化的临床应用.国外医学(临床放射学分册)，2006，29(1):36-39.
14	Fuentes MA, Keith CJ, Griffiths M，et al. Hapatic haemodynamics: interrelationships between contrast enhancement and perfusion on CT and Doppler perfusion indices. Br J Radiol，2002，75(889):17-23.
15	Annet L, Materne R, Danse E，et al. Hepatic flow parameters measured with MR imaging and Doppler Us:correlations with degree of cirrhosis and portal hypertention. Radiology，2003，229(2):404-414.

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