中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (07): 598-601.

• 论著 • 上一篇    下一篇

肝切除术前实时组织弹性成像评估肝纤维化程度及门静脉压力

叶新平a，杨    红b，吕自力c，彭    涛a，黎乐群a，覃    晓a，彭民浩a，肖开银a， 苏智雄a，覃    忠a，尚丽明a，苏    铭a   

  1. 广西医科大学第一附属医院  a.肝胆外科 b.超声科 c.病理科，广西南宁530021
  • 出版日期:2011-07-01 发布日期:2011-06-17

  • Online:2011-07-01 Published:2011-06-17

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摘要：

目的    探讨实时组织弹性成像（real-time tissue elastography， RTE）在术前评估肝纤维化程度及门静脉压力的可行性。方法    2010年6月至2010年8月广西医科大学第一附属医院对34例肝切除病人术前实时超声检测肝组织弹性，术中测量门静脉压力（portal vein pressure，PVP），并结合临床及术后病理进行分析。结果    术前实时组织弹性成像定量参数（AREA%）中位数为32.2%（6.8%~77.9%）。术中门静脉压力中位数为19（13~28）cmH2O（1cmH2O=0.098kPa）。肝纤维化分期F0 4例，F1 8例，F2 9例，F3 1例，F4 12例。PVP值与肝纤维化分级显著相关（spearman相关系数为0.548，P<0.001）。AREA%随肝纤维分级的升高而显著增加（P<0.01），与肝纤维化分级显著相关（spearman相关系数为0.642，P<0.001）。AREA%与PVP有着显著的线性相关（R=0.753，P<0.001）。AREA%判断重度纤维化的ROC曲线下的面积为0.81。结论    实时组织弹性成像可在术前提供一个方便、无创的新方法来评估肝纤维化的程度及门静脉压力。

关键词: 实时组织弹性成像, 肝纤维化, 门静脉压力

Abstract:

Real-time tissue elastography imaging in the preoperative assessment liver fibrosis and portal vein pressure for hepatectomy        YE Xin-ping* , YANG Hong, Lü Zi-li, et al．*Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021,China
Corresponding author: YE Xin-ping, E-mail: yexp507@yahoo.com.cn
Abstract    Objective    To explore the feasibility of the real-time tissue elastography (RTE) imaging quantitative method in the evaluation of liver fibrosis and portal vein pressure(PVP). Methods    Thirty-four cases were examined by RTE and measured intraoperative portal vein pressure(PVP) before hepatectomy between June 2010 and August 2010 in the First Affiliated Hospital of Guangxi Medical University. All the examination data were compared with clinical and pathological characteristics. Results    The result of RTE was described as AREA%, which indicates the percentage of hard tissue and represents the hard tissue domain and ranges from 6.8 to 77.9% (median 32.2%). The measurement of intraoperative portal vein pressure was 19 (13-28) cmH2O. According to liver fibrosis stage, all the cases were divided into F0 4 cases, F1 8 cases, F2 9 cases, F3 1 case, F4 12 cases, respectively. PVP was correlated with the liver fibrosis stage significantly (spearman correlation coefficient was 0.548, P<0.001). There were significant differences between each fibrosis stage and AREA%(P<0.001). AREA% was significantly correlated with the PVP (R=0.753, P <0.001).The diagnostic accuracy expressed as areas under receiver operating characteristic (ROC)curves was 0.81 for the diagnosis of severe fibrosis. Conclusion    RTE provides a new convenient non-invasive method to assess liver fibrosis and PVP before operation.

Key words: real-time tissue elastography, liver fibrosis, portal vein pressure