功能性肝脏体积的测量及临床意义

目的:测定肝脏功能性体积并探讨其临床意义。方法:用SPECT肝胶体显像方法测定功能性肝脏体积,分别以边界描记法和代表象素法进行标准体积模型实验和临床病例研究。对28例肝硬化门静脉高压症病人及10例无肝脏疾病者进行肝脏体积的测量和常规肝功能检查,并随访术后脑病发生情况。结果:边界描记法和代表象素法所测得结果与标准体积之间均呈高度显著正相关(r=0.998,P＜0.001和r=0.988,P＜0.001),平均误差分别为2.65%和5.26%。Child-Pugh B、C级者肝脏体积明显小于对照组(P＜0.01),各肝功能分级者间肝脏体积差异显著。肝脏体积与血浆白蛋白水平、总胆红素值及凝血酶原时间之间均呈密切相关。联合手术后不管肝功能是A级或B级,发生脑病者的肝脏体积均较小。结论:SPECT代表象素法能精确而方便地测量肝脏功能性体积。肝脏体积较Child-Pugh分级更能准确地反映肝脏的储备功能。

Functional Liver Volume Measurement by SPECT and Its Clinical Significance.

ve:To estimate functional liver volume by SPECT and to investigate its clinical sig-nificance. Methods: The study consisted of phantom and clinical patients including 28 cirrhotics and 10normal controls, the examinations of 99mTc sodium phytate SPECT and routine tests of hepatic func-tion were performed. Both phantom volume and liver volume were calculated by classic edging defi-ning technique and representative voxel technique respectively. The cases who were undergone theoperation of devascularization combined with portal-systemic shunt were followed up at least 7 month.Results: Phantom studies showed that the mean error of edging defining technique and representativevoxel technique were 2.65% and 5.26% respectively. Comparing with normal controls, the liver volumeof Child B and C decreased significantly(P<0.0l). The differences of liver volume were related to Chi1d-Pugh classification. Serum albumin level, PT and serum bilirubin were correlated with liver volume.Hepatic encephalopathy occured in patients with smaller liver volume. Conclusions: Liver vo1ume de-termination by SPECT with representative voxel technique was both accuracy and easy as an impor-tant index for clinical liver reserve function evaluation.