• 西安交通大學醫(yī)學院第二附屬醫(yī)院普外科(西安710004);

目的 　通過D-山梨醇清除率測量肝功能性血流量、CT測量肝體積變化來評價病肝儲備功能，探討其臨床應用價值。
方法 　所選研究對象為92例肝炎后肝硬變、門靜脈高壓癥患者(肝硬變組)，20例健康志愿者作為對照組。采用穩(wěn)態(tài)滴注法靜脈滴注D-山梨醇，于滴注前、滴注后120、150、180 min分別采血和收集尿液，采用酶分光光度法測量D-山梨醇血濃度和尿濃度，計算出D-山梨醇肝清除率（CLH）； 結合彩色多普勒超聲測定肝總血流量(QTOTAL)，求出肝內(nèi)分流率(RINS)； 通過腹部CT掃描求出肝硬變患者肝臟體積變化率。分析各指標與Child-Pugh肝功能分級和術后并發(fā)癥之間的相互關系。
結果 　靜脈滴注D-山梨醇,120 min后達穩(wěn)態(tài)血藥濃度，對照組為(0.189±0.05) mmol/L，肝硬變組為(0.358±0.06) mmol/L,肝硬變組明顯高于對照組(P lt;0.01)。對照組的CLH為(1 248.3±210.5) ml/min、RINS為(8.37±3.32)%,肝硬變組的CLH為(812.7±112.4) ml/min、RINS為(36.54±10.65)%,2組相應指標比較,差異均有統(tǒng)計學意義(P lt;0.01)；　對照組和肝硬變組的QTOTAL值〔(1 362.4±126.9) ml/min比(1 280.6±131.4) ml/min〕比較，差異無統(tǒng)計學意義(P gt;0.05)。在肝硬變組中， Child A級肝臟平均體積為(1 057±249) cm3，Child B級為(851±148) cm3，Child C級為(663±77) cm3，三者之間差異有統(tǒng)計學意義(P lt;0.05)； Child B級和Child C級與Child A級比較，肝臟平均體積明顯減小(P lt;0.05,P lt;0.01)。當CLH lt;600 ml/min、病肝體積縮小率為40%以上時，術后并發(fā)癥發(fā)生率達78.6%。CLH、肝體積變化率與Child肝功能分級間均存在著交錯現(xiàn)象。
結論 　D-山梨醇肝清除率、CT掃描測定病肝體積能夠客觀地評價肝固有代謝容量和肝功能性血流量的變化，有助于正確理解病肝儲備功能狀況，為合理地確定治療方案、選擇手術方式和手術時機奠定基礎。

引用本文： 黎一鳴,李華,吉鴻,徐心. D-山梨醇肝清除率聯(lián)合CT肝體積測量評價病肝儲備功能. 中國普外基礎與臨床雜志, 2009, 16(4): 285-289. doi: 復制

1. Zoli M, Magalotti D, Bianchi G, et al. Total and functional hepatic blood flow decrease in parallel with ageing [Ｊ]. Age Ageing, 1999; 28(1): 29-33.
2. Proctor E, Chatamra K. High yield micronodular cirrhosis in the rat [Ｊ]. Gastroenterology, 1982; 83(6): 1183-1190.
3. Schiano TD, Bodian C, Schwartz ME, et al. Accuracy and significance of computed tomographic scan assessment of hepatic volume in patients undergoing liver transplantation [Ｊ]. Transplantation, 2000; 69(4): 545-550.
4. Rosemurgy AS 2nd, Norman JG, Goode SE. Does the direction of portal blood flow determine outcome with small-diameter prosthetic H-graft portacaval shunt? [Ｊ]. Surgery, 1997; 121(1): 95-101.
5. Sugimoto H, Kaneko T, Inoue S, et al. Simultaneous Doppler measurement of portal venous peak velocity, hepatic arterial peak velocity, and splenic arterial pulsatility index for assessment of hepatic circulation [Ｊ]. Hepatogastroenterology, 2002; 49(45): 793-797.
6. Keiding S, Engsted E, Ott P. Sorbitol as a test substance for measurement of liver plasma flow in humans [Ｊ]. Hepatology, 1998; 28(1): 50-56.
7. Heymsfield SB, Rolandelli R, Casper K, et al. Application of electromagnetic and sound waves in nutritional assessment [Ｊ]. JPEN J Parenter Enteral Nutr, 1987; 11(5 Suppl): 64S-69S.
8. Urata K, Hashikura Y, Ikegami T, et al. Standard liver volume in adults [Ｊ]. Transplant Proc, 2000; 32(7): 2093-2094.
9. Zipprich A, Steudel N, Behrmann C, et al. Functional significance of hepatic arterial flow reserve in patients with cirrhosis [Ｊ]. Hepatology, 2003; 37(2): 385-392.
10. Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection [Ｊ]. J Gastrointest Surg, 2003; 7(3): 325-330.
11. Blker H, Theuer D, Otto HF. Pathology of liver cirrhosis and portal hypertension [Ｊ]. Radiologe, 2001; 41(10): 833-839.
12. Pan Z, Wu XJ, Li JS, et al. Functional hepatic flow in patients with liver cirrhosis [Ｊ].World J Gastroenterol, 2004; 10(6): 915-918.
13. Burggraaf J, Schoemaker RC, Lentjes EG, et al. Sorbitol as a marker for drug-induced decreases of variable duration in liver blood flow in healthy volunteers [Ｊ]. Eur J Pharm Sci, 2000; 12(2): 133-139.
14. Molino G, Avagnina P, Belforte G, et al. Assessment of the hepatic circulation in humans: new concepts based on evidence derived from a D-sorbitol clearance method [Ｊ]. J Lab Clin Med, 1998; 131(5): 393-405.
15. 任貴兵, 錢崇寬, 趙端儀, 等. D-山梨醇清除率法補充吲哚氰綠潴留率和Child-Pugh分級評估肝儲備功能 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(4): 271-273.
16. Molino G, Avagnina P, Ballarè M, et al. Combined evaluation of total and functional liver plasma flows and intrahepatic shunting [Ｊ]. Dig Dis Sci, 1991; 36(9): 1189-1196.
17. Koranda P, Myslivecek M, Erban J, et al. Hepatic perfusion changes in patients with cirrhosis indices of hepatic arterial blood flow [Ｊ]. Clin Nucl Med, 1999; 24(7): 507-510.
18. Piscaglia F, Donati G, Serra C, et al. Value of splanchnic Doppler ultrasound in the diagnosis of portal hypertension [Ｊ]. Ultrasound Med Biol, 2001; 27(7): 893-899.
19. Imsamran W, Leelawat K, Leelawat T, et al. Simple technique in the measurement of liver volume [Ｊ]. J Med Assoc Thai, 2003; 86(2): 151-156.
20. Dunkelberg JC, Feranchak AP, Fitz JG. Liver cell volume regulation: size matters [Ｊ]. Hepatology, 2001; 33(6): 1349-1352.
21. 潘崢, 吳性江, 黎介壽, 等. 肝硬化門靜脈高壓癥患者肝臟功能性血流量檢測的臨床意義 [Ｊ]. 中華普通外科雜志, 2004; 19(11): 653-655.
22. 王茂春, 冷希圣, 彭吉潤, 等. 肝硬變門靜脈高壓癥患者肝體積測量研究及其臨床意義 [Ｊ]. 中國普外基礎與臨床雜志, 2003; 10(6): 586-592.
23. Hoshida Y, Shiratori Y, Koike Y, et al. Hepatic volumetry to predict adverse events in percutaneous ablation of hepatocellular carcinoma [Ｊ]. Hepatogastroenterology, 2002; 49(44): 451-455.
  1. 1. Zoli M, Magalotti D, Bianchi G, et al. Total and functional hepatic blood flow decrease in parallel with ageing [Ｊ]. Age Ageing, 1999; 28(1): 29-33.
  2. 2. Proctor E, Chatamra K. High yield micronodular cirrhosis in the rat [Ｊ]. Gastroenterology, 1982; 83(6): 1183-1190.
  3. 3. Schiano TD, Bodian C, Schwartz ME, et al. Accuracy and significance of computed tomographic scan assessment of hepatic volume in patients undergoing liver transplantation [Ｊ]. Transplantation, 2000; 69(4): 545-550.
  4. 4. Rosemurgy AS 2nd, Norman JG, Goode SE. Does the direction of portal blood flow determine outcome with small-diameter prosthetic H-graft portacaval shunt? [Ｊ]. Surgery, 1997; 121(1): 95-101.
  5. 5. Sugimoto H, Kaneko T, Inoue S, et al. Simultaneous Doppler measurement of portal venous peak velocity, hepatic arterial peak velocity, and splenic arterial pulsatility index for assessment of hepatic circulation [Ｊ]. Hepatogastroenterology, 2002; 49(45): 793-797.
  6. 6. Keiding S, Engsted E, Ott P. Sorbitol as a test substance for measurement of liver plasma flow in humans [Ｊ]. Hepatology, 1998; 28(1): 50-56.
  7. 7. Heymsfield SB, Rolandelli R, Casper K, et al. Application of electromagnetic and sound waves in nutritional assessment [Ｊ]. JPEN J Parenter Enteral Nutr, 1987; 11(5 Suppl): 64S-69S.
  8. 8. Urata K, Hashikura Y, Ikegami T, et al. Standard liver volume in adults [Ｊ]. Transplant Proc, 2000; 32(7): 2093-2094.
  9. 9. Zipprich A, Steudel N, Behrmann C, et al. Functional significance of hepatic arterial flow reserve in patients with cirrhosis [Ｊ]. Hepatology, 2003; 37(2): 385-392.
  10. 10. Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection [Ｊ]. J Gastrointest Surg, 2003; 7(3): 325-330.
  11. 11. Blker H, Theuer D, Otto HF. Pathology of liver cirrhosis and portal hypertension [Ｊ]. Radiologe, 2001; 41(10): 833-839.
  12. 12. Pan Z, Wu XJ, Li JS, et al. Functional hepatic flow in patients with liver cirrhosis [Ｊ].World J Gastroenterol, 2004; 10(6): 915-918.
  13. 13. Burggraaf J, Schoemaker RC, Lentjes EG, et al. Sorbitol as a marker for drug-induced decreases of variable duration in liver blood flow in healthy volunteers [Ｊ]. Eur J Pharm Sci, 2000; 12(2): 133-139.
  14. 14. Molino G, Avagnina P, Belforte G, et al. Assessment of the hepatic circulation in humans: new concepts based on evidence derived from a D-sorbitol clearance method [Ｊ]. J Lab Clin Med, 1998; 131(5): 393-405.
  15. 15. 任貴兵, 錢崇寬, 趙端儀, 等. D-山梨醇清除率法補充吲哚氰綠潴留率和Child-Pugh分級評估肝儲備功能 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(4): 271-273.
  16. 16. Molino G, Avagnina P, Ballarè M, et al. Combined evaluation of total and functional liver plasma flows and intrahepatic shunting [Ｊ]. Dig Dis Sci, 1991; 36(9): 1189-1196.
  17. 17. Koranda P, Myslivecek M, Erban J, et al. Hepatic perfusion changes in patients with cirrhosis indices of hepatic arterial blood flow [Ｊ]. Clin Nucl Med, 1999; 24(7): 507-510.
  18. 18. Piscaglia F, Donati G, Serra C, et al. Value of splanchnic Doppler ultrasound in the diagnosis of portal hypertension [Ｊ]. Ultrasound Med Biol, 2001; 27(7): 893-899.
  19. 19. Imsamran W, Leelawat K, Leelawat T, et al. Simple technique in the measurement of liver volume [Ｊ]. J Med Assoc Thai, 2003; 86(2): 151-156.
  20. 20. Dunkelberg JC, Feranchak AP, Fitz JG. Liver cell volume regulation: size matters [Ｊ]. Hepatology, 2001; 33(6): 1349-1352.
  21. 21. 潘崢, 吳性江, 黎介壽, 等. 肝硬化門靜脈高壓癥患者肝臟功能性血流量檢測的臨床意義 [Ｊ]. 中華普通外科雜志, 2004; 19(11): 653-655.
  22. 22. 王茂春, 冷希圣, 彭吉潤, 等. 肝硬變門靜脈高壓癥患者肝體積測量研究及其臨床意義 [Ｊ]. 中國普外基礎與臨床雜志, 2003; 10(6): 586-592.
  23. 23. Hoshida Y, Shiratori Y, Koike Y, et al. Hepatic volumetry to predict adverse events in percutaneous ablation of hepatocellular carcinoma [Ｊ]. Hepatogastroenterology, 2002; 49(44): 451-455.