Gd-EOB-DTPA增强MRI联合残余肝脏体积测定在肝切除术前储备功能评估中的价值

肝脏 ›› 2021, Vol. 26 ›› Issue (4): 388-391.

Gd-EOB-DTPA增强MRI联合残余肝脏体积测定在肝切除术前储备功能评估中的价值

贠桂侠, 陆松, 孟春

230000 合肥安徽省第二人民医院放射科

收稿日期:2020-06-21 发布日期:2021-05-22
通讯作者: 贠桂侠, Email:739804609@qq.com
基金资助:
安徽省科技攻关项目(1604a0802095)

The application value of Gd-EOB-DTPA enhanced MRI coupled with residual liver volume measurement in evaluating liver reserve function

YUN Gui-xia, LU Song, MENG Chun

The Second people’s Hospital of Anhui Province, Hefei, 230000, China

Received:2020-06-21 Published:2021-05-22
Contact: YUN Gui-xia, Email:739804609@qq.com

摘要/Abstract

摘要： 目的研究钆塞酸二钠(Gd-EOB-DTPA)增强MRI联合残余肝脏体积测定在肝切除术前储备功能评估中的应用价值。方法本研究纳入2016年6月至2019年12月安徽省第二人民医院收治手术治疗的肝癌患者, 所有患者均在术前进行Gd-EOB-DTPA增强MRI以及模拟肝切除并进行残余肝脏体积测定, 并观察患者术后的肝功能恢复情况。结果本研究共纳入415例肝癌肝切除患者, 其中56例患者发生了术后肝功能不全, 发生率为13.5%。单因素分析分析发现术后肝功能不全组患者的术前血小板水平(P=0.036)及残余肝脏体积率(remnant liver volume rate, RLVR)× Gd-EOB-DTPA肝脏实际摄取信号强度(TSI)(P=0.012)明显低于良好组。术后肝功能不全组患者的肝门阻断时间(P=0.049)及术中出血量(P=0.032)明显高于术后恢复良好组。logistic多因素回归分析结果发现RLVR × TIS是肝癌肝切除术后肝功能不全的唯一危险因素。结论 Gd-EOB-DTPA增强MRI联合残余肝脏体积测定可以较为准确的预测术后肝功能不全的发生, 是一种较为可靠的肝脏储备功能评估手段。

关键词: 磁共振成像, 钆塞酸二钠, 肝储备功能, 术后肝功能不全

Abstract: Objective To study on the value of Gd-EOB-DTPA enhanced Magnetic Resonance Imaging(MRI)combined with residual liver volume measurement in evaluating liver reserve function before surgery.Methods A total of 415 liver cancer patients treated in our hospital from July 2016 to December 2019 were included in this study. All patients underwent Gd-EOB-DTPA enhanced MRI and residual liver volume measurement before operation. Liver function was observed after the surgery. Results 56 patients (13.5%) developed postoperative hepatic insufficiency. By univariate analysis it was revealed that preoperative platelet levels (P=0.036) and residual liver volume rate (RLVR)×Gd-EOB-DTPA actual liver uptake signal intensity (TSI) (P=0.012) of the patients in postoperative hepatic insufficiency group was significantly lower than those in the recovery group. Hepatic hilar occlusion time (P=0.049) and intraoperative blood loss (P=0.032) in patients with postoperative hepatic insufficiency group were significantly higher than those in postoperative recovery group. By logistic multivariate regression analysis it was found that RLVR×TIS was the only risk factor for postoperative hepatic insufficiency.Conclusion Gd-EOB-DTPA enhanced MRI combined with residual liver volume measurement can accurately predict the occurrence of postoperative hepatic insufficiency, and it is a reliable method for evaluating liver reserve function.

Key words: Magnetic Resonance Imaging, Laparoscopic, Gd-EOB-DTPA, Liver reserve function, Postoperative hepatic insufficiency

贠桂侠, 陆松, 孟春. Gd-EOB-DTPA增强MRI联合残余肝脏体积测定在肝切除术前储备功能评估中的价值[J]. 肝脏, 2021, 26(4): 388-391.

YUN Gui-xia, LU Song, MENG Chun. The application value of Gd-EOB-DTPA enhanced MRI coupled with residual liver volume measurement in evaluating liver reserve function[J]. Chinese Hepatolgy, 2021, 26(4): 388-391.

参考文献

[1] 曹洪庆.精准肝切除术治疗肝细胞肝癌患者近期疗效及远期预后生存研究.按摩与康复医学, 2020, 11:42-44.
[2] 高本见, 罗佳, 刘莹, 等.挽救性肝移植与再次肝切除治疗术后复发性肝癌疗效对比的Meta分析.中国普通外科杂志, 2020, 29:1-10.
[3] 王中会, 吕洪亮, 孙铁梁, 等.MSCT评估肝癌伴肝硬化患者肝脏储备功能中的价值分析.临床医药文献电子杂志, 2019, 6:36.
[4] 李斌, 杨建峰, 吕单玲, 等.肝硬化CT分级对肝癌介入治疗后肝储备功能及预后的评估价值.浙江实用医学, 2019, 24:271-272, 281.
[5] 张涛, 陆健, 张学琴, 等.钆塞酸二钠增强T₁-mapping 成像和DWI对肝纤维化分期的评估价值.放射学实践, 2020, 35:203-207.
[6] 张涛, 陆健, 张学琴, 等.Gd-EOB-DTPA 增强T₁ mapping 成像对肝纤维化分期的评估价值.临床放射学杂志, 2019, 38:2096-2099.
[7] 陈敏, 侯洪伟.肝切除术后肝功能失代偿的相关风险指标分析.医学信息, 2019, 32:83-87.
[8] 张健.肝切除术后肝衰竭的临床研究进展.医疗装备, 2019, 32:192-193.
[9] 胡正斌, 周鑫, 熊艳, 等.吲哚菁绿清除试验在肝移植患者中的应用进展.实用器官移植电子杂志, 2019, 7:141-143.
[10] 张尊义, 黄志勇.肝脏储备功能研究及其进展.临床外科杂志, 2017, 25:235-237.
[11] 康杜甫, 孙志为, 唐建中, 等.血清γ-球蛋白联合吲哚菁绿清除试验评估肝脏储备功能的实验研究.昆明医科大学学报, 2014, 35:23-26.
[12] 吕倩, 周锐志, 李颖端, 等.Gd-EOB-DTPA增强磁共振信号强度评价肝功能的价值研究.磁共振成像, 2019, 10:752-756.
[13] 胡燕, 程龙, 朱永强, 等.基于Gd-EOB-DTPA增强MRI对肝切除术后残肝再生特征的研究.西南国防医药, 2019, 29:817-819.
[14] 杨睿, 张洪波, 樊中营, 等.Gd-EOB-DTPA肝脏MRI动态增强扫描评估肝功能的可行性.医学影像学杂志, 2019, 29:969-972.
[15] Araki K, Harimoto N, Kubo N, et al. Functional remnant liver volumetry using Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) predicts post-hepatectomy liver failure in resection of more than one segment. HPB (Oxford), 2020, 22:318-327.