CT测量残肝比在肝母细胞瘤患儿术前评估中的应用
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摘要
目的探讨CT测量残余肝脏体积比(残肝比)在肝母细胞瘤患儿术前评估中的应用价值。方法选取40例经手术病理证实的肝母细胞瘤患儿,平均年龄(1.8±0.8)岁,术前均行增强CT检查,并测量全肝脏体积、预切除肝脏体积,计算标准化肝脏体积、残余肝脏体积,按照公式残肝比=残余肝脏体积/标准化肝脏体积×100%计算残肝比。术中以水浸法测量实际手术切除肝脏体积,并与CT测量预切除肝脏体积进行比较;以ROC曲线评价残肝比预测术后肝功能中重度与轻度损害的效能。结果术前CT测量预切除肝脏体积为(393.62±216.54)cm~3,术中以水浸法测得实际肝脏切除体积为(388.38±207.56)cm~3,差异无统计学意义(t=1.679,P=0.101)。患儿残余肝脏体积为(234.55±70.42)cm~3,残肝比为(63.64±13.70)%。ROC曲线结果显示残肝比预测术后肝功能中重度与轻度损害的AUC为0.837(P=0.016),临界值为56.32%,敏感度为86.7%,特异度为70.0%。结论肝母细胞瘤患儿术前采用CT计算残肝比,对于选择手术方案以及术后肝功能评估具有重要价值。
Objective To assess the value of residual liver volume ratio measured with CT for preoperative evaluation in pediatric hepatoblastoma. Methods Totally 40 hepatoblastoma patients confirmed by pathology with the average age of(1.8±0.8)years were enrolled. All patients underwent pre-operation enhanced CT scan. The total liver volume, the predicted resected liver volume were measured, and the standard liver volume, the residual liver volume were calculated, respectively. The residual liver volume ratio was calculated with the formula of residual liver volume ratio=residual liver volume/standard liver volume×100%. The volume of the actual resected liver was measured by water immersion method and then compared with the volume of the pre-resected liver measured with CT. ROC curve was used to evaluate the efficacy of residual liver volume ratio for prediction of moderate and severe liver dysfunction. Results The predicted resected liver volume and actual resected liver volume was(393.62±216.54)cm~3 and(388.38±207.56)cm~3, respectively, with no significant difference(t=1.679, P=0.101). The residual liver volume was(234.55±70.42)cm~3, and the residual liver volume ratio was(63.64±13.70)%. AUC of ROC curve for prediction of moderate and severe liver dysfunction was 0.837(P=0.016), the critical value was 56.32%, and the sensitivity and the specificity was 86.7% and 70.0%, respectively. Conclusion The preoperative calculation of residual liver volume ratio with CT in children with hepatoblastoma is a great value in the selection of surgical option and evaluation of postoperative liver function.
Objective To assess the value of residual liver volume ratio measured with CT for preoperative evaluation in pediatric hepatoblastoma. Methods Totally 40 hepatoblastoma patients confirmed by pathology with the average age of(1.8±0.8)years were enrolled. All patients underwent pre-operation enhanced CT scan. The total liver volume, the predicted resected liver volume were measured, and the standard liver volume, the residual liver volume were calculated, respectively. The residual liver volume ratio was calculated with the formula of residual liver volume ratio=residual liver volume/standard liver volume×100%. The volume of the actual resected liver was measured by water immersion method and then compared with the volume of the pre-resected liver measured with CT. ROC curve was used to evaluate the efficacy of residual liver volume ratio for prediction of moderate and severe liver dysfunction. Results The predicted resected liver volume and actual resected liver volume was(393.62±216.54)cm~3 and(388.38±207.56)cm~3, respectively, with no significant difference(t=1.679, P=0.101). The residual liver volume was(234.55±70.42)cm~3, and the residual liver volume ratio was(63.64±13.70)%. AUC of ROC curve for prediction of moderate and severe liver dysfunction was 0.837(P=0.016), the critical value was 56.32%, and the sensitivity and the specificity was 86.7% and 70.0%, respectively. Conclusion The preoperative calculation of residual liver volume ratio with CT in children with hepatoblastoma is a great value in the selection of surgical option and evaluation of postoperative liver function.
引文
[1] Andres AM,Hernandez F,Lopez-Santamaría M,et al.Surgery of liver tumors in children in the last 15 years.Eur J Pediatr Surg,2007,17(6):387-392.
[2] 赵静,董蒨,江布先,等.CT三维重建及肝脏体积测定在小儿肝脏肿瘤手术中的应用.临床小儿外科杂志,2009,8(4):13-16.
[3] Herden U,Wischhusen F,Heinemann A,et al.A formula to calculate the standard liver volume in children and its application in pediatric liver transplantation.Transpl Int,2013,26(12):1217-1224.
[4] 潘华锋.CT检查预测肝癌手术切除安全性的价值.肝胆外科杂志,2000,8(3):185-188.
[5] Hiyama E,Hishiki T,Watanabe K,et al.Mortality and morbidity in primarily resected hepatoblastomas in Japan:Experience of the JPLT (Japanese Study Group for Pediatric Liver Tumor) trials.J Pediatrc Surg,2015,50(12):2098-2101.
[6] Zhang Y,Zhang W,Tang S,et al.A single-center retrospective study of pediatric hepatoblastom.Oncol Lett,2016,12(5):3919-3925.
[7] Devi LP,Kumar R,Handique A,et al.Hepatoblastoma—a rare liver tumor with review of literature.J Gastrointest Cancer,2014,45(Suppl 1):261-264.
[8] Al-Jiffry BO.Adult hepatohlastoma:A case report and literature review.Int J Surg Case Rep,2013,4(2):204-207.
[9] 董蒨,江布先,张虹,等.螺旋CT三维成像在小儿巨大及复杂部位肝脏肿瘤诊治中的应用.中华小儿外科杂志,2006,27(1):6-9.
[10] 陶肇堃,王珊.小儿肝母细胞瘤的诊断与治疗进展.世界临床医学,2016,10(13):100-101.
[11] 王桂林,梅铭恵.残肝体积安全临界值的研究进展.中华普通外科杂志,2012,21(1):99-102.
[12] 方程,宣吉晴,雷正明.肝脏体积与肝脏储备功能的关系及其临床应用.中华肝胆外科杂志,2008,14(10):749-751.
[13] Olthof PB,Tomassini F,Huespe PE,et al.Hepatobiliary scintigraphy to evaluate liver function in associating liver partition and portal vein ligation for staged hepatectomy:Liver volume over estimates liver function.Surgery,2017,162(4):775-783.
[14] Olthof PB,Schadde E,van Lienden KP,et al.Hepatic parenchymal transection increases liver volume but not function after portal vein embolization in rabbits.Surgery,2017,162(4):732-741.
[2] 赵静,董蒨,江布先,等.CT三维重建及肝脏体积测定在小儿肝脏肿瘤手术中的应用.临床小儿外科杂志,2009,8(4):13-16.
[3] Herden U,Wischhusen F,Heinemann A,et al.A formula to calculate the standard liver volume in children and its application in pediatric liver transplantation.Transpl Int,2013,26(12):1217-1224.
[4] 潘华锋.CT检查预测肝癌手术切除安全性的价值.肝胆外科杂志,2000,8(3):185-188.
[5] Hiyama E,Hishiki T,Watanabe K,et al.Mortality and morbidity in primarily resected hepatoblastomas in Japan:Experience of the JPLT (Japanese Study Group for Pediatric Liver Tumor) trials.J Pediatrc Surg,2015,50(12):2098-2101.
[6] Zhang Y,Zhang W,Tang S,et al.A single-center retrospective study of pediatric hepatoblastom.Oncol Lett,2016,12(5):3919-3925.
[7] Devi LP,Kumar R,Handique A,et al.Hepatoblastoma—a rare liver tumor with review of literature.J Gastrointest Cancer,2014,45(Suppl 1):261-264.
[8] Al-Jiffry BO.Adult hepatohlastoma:A case report and literature review.Int J Surg Case Rep,2013,4(2):204-207.
[9] 董蒨,江布先,张虹,等.螺旋CT三维成像在小儿巨大及复杂部位肝脏肿瘤诊治中的应用.中华小儿外科杂志,2006,27(1):6-9.
[10] 陶肇堃,王珊.小儿肝母细胞瘤的诊断与治疗进展.世界临床医学,2016,10(13):100-101.
[11] 王桂林,梅铭恵.残肝体积安全临界值的研究进展.中华普通外科杂志,2012,21(1):99-102.
[12] 方程,宣吉晴,雷正明.肝脏体积与肝脏储备功能的关系及其临床应用.中华肝胆外科杂志,2008,14(10):749-751.
[13] Olthof PB,Tomassini F,Huespe PE,et al.Hepatobiliary scintigraphy to evaluate liver function in associating liver partition and portal vein ligation for staged hepatectomy:Liver volume over estimates liver function.Surgery,2017,162(4):775-783.
[14] Olthof PB,Schadde E,van Lienden KP,et al.Hepatic parenchymal transection increases liver volume but not function after portal vein embolization in rabbits.Surgery,2017,162(4):732-741.