肝切除术前肝储备功能的评估方法

裴俊鹏; 丁佑铭

doi:10.3969/j.issn.1001-5256.2023.05.034

肝切除术前肝储备功能的评估方法

DOI: 10.3969/j.issn.1001-5256.2023.05.034

裴俊鹏,
丁佑铭^, ,

武汉大学人民医院肝胆外科，武汉 430061

基金项目:

中央引导地方科技发展专项 (2019A4005)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：裴俊鹏负责撰写论文，丁佑铭指导撰写文章并最后定稿。

详细信息

通信作者:
丁佑铭，dingym62@163.com (ORCID: 0000-0003-4395-4210)

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出版历程
- 收稿日期: 2022-09-17
- 录用日期: 2022-10-24
- 出版日期: 2023-05-20

Methods for evaluating liver reserve function before hepatectomy

Junpeng PEI,
Youming DING^{,
,}

Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan 430061, China

Research funding:

The Central Government Guides Local Science and Technology Development Projects (2019A4005)

More Information

Corresponding author: DING Youming, dingym62@163.com (ORCID: 0000-0003-4395-4210)

摘要

摘要: 目前肝切除术已成为绝大多数肝胆良恶性病变的首选治疗方式。肝功能衰竭是肝切除术后的常见并发症，对于恶性疾病，如何最大程度清除病灶并降低术后肝功能衰竭发生率，是目前肝切除术面对的重点问题。术前对肝脏储备功能正确、充分的评估，可以为肝脏疾病进展、治疗效果及预后提供判断依据。目前，对肝脏储备功能及手术可行性的评估方法繁多，各有其优缺点，尚无单一全面性的评估方法，对目前常用评估方法的特点及进展进行综述。
- 肝切除术 /
- 肝功能衰竭 /
- 肝脏功能储备 /
- 术前评估
Abstract: At present, hepatectomy has become the preferred treatment modality for most benign and malignant hepatobiliary diseases. Liver failure is a common complication after hepatectomy, and for malignant diseases, how to remove the lesion to the maximum extent and reduce the incidence rate of liver failure after hepatectomy is the key problem at present. Accurate and adequate preoperative evaluation of liver reserve function can provide a basis for judging the progression, therapeutic outcome, and prognosis of liver diseases. There are currently various methods for evaluating liver reserve function and surgical feasibility, each with its own advantages and disadvantages, and there is still a lack of a single comprehensive evaluation method. This article reviews the characteristics of commonly used evaluation methods and related research advances.
- Hepatectomy /
- Liver Failure /
- Liver Function Reserve /
- Preoperative Assessment

HTML全文

表 1 常见超声技术的作用及干扰因素

Table 1. The role and interference factors of common ultrasound techniques

超声技术	缩写	作用	干扰因素
静态弹性成像的实时弹性成像^[8-9]	RTE	显示病灶的大小、数量以及对周边组织的侵犯情况	肥胖、腹腔大血管、腹腔气体、腹腔积液^[10]
动态弹性成像的瞬时弹性成像^[11-12]	TE	量化肝脏硬度，无创、简便易操作、快速安全、可重复、经济实惠存在明显肝细胞炎症及胆汁淤积
声辐射力脉冲成像^[13]	ARFI	量化肝脏硬度及病变组织硬度	多发性肝脏占位性、大量腹水、肝脏萎缩
剪切波弹性成像	2D-SWE	量化肝脏硬度，由TE衍生而来，比TE具有更强的识别肝纤维化和肝硬化的能力^[14]	存在明显肝细胞炎症及胆汁淤积
超声造影技术^[15]	CEUS	实时、动态连续的显示肝脏血流灌注情况	合并严重脂肪肝及局灶性增生结节
组织结构声学定量技术	ASQ	无创、定量，操作便捷，可重复性高，预测肝癌价值高^[16]	肝硬化程度重，无正常肝组织作为参照

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表 2 MCP评分系统^[31]

Table 2. MCP Scoring system

变量	1分	2分	3分
总胆红素(μmol/mL)	＜34	34~51	＞51
Alb(g/L)	＞35	28~35	＜28
PT延长(s)	＜4	4~6	＞6
PA(mg/L)
男	＞190	130~190	＜130
女	＞170	120~170	＜120
注：得分4分为MCP-1级，得分5分为MCP-2级，得分≥6分为MCP-3级。

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