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。

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。

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。

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。

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

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.

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.

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.