标准肝体积公式评估-中国人正常肝脏体积预测公式的评估

1、Online Submissions: wjgdoi:10.3748/wjg.15.4062World J Gastroenterol 2009 August 28; 15(32): 4062-4066 World Journal of Gastroenterology ISSN 1007-9327? 2009 The WJG Press and Baishide ng. All rights reserved.BRIEF ARTICLESEvaluation of standard liver volume formulae for ChineseadultsZhe ng-R ong Shi

2、, Lu-Nan Yan, Bo Li, Tia n-Fu Wen© 1 94-2010 China Academic Jutunal Eketrunic Publishing House. All ritihts reserved. hitp:f/www.enkLM© 1 94-2010 China Academic Jutunal Eketrunic Publishing House. All ritihts reserved. hitp:f/www.enkLMMETHODS: Data from 70 cases of liv ing donor liver tran

3、 spla ntati on (LDLT) performed at our tra nspla nta- tion centers between January 2008 and April 2009 were an alyzed. SLV was estimated using our rece ntly reported formula the Chengdu formula: SLV (mL) = 11.5 weight (kg) + 334 and other reported formulae used for Chin ese adults. Actual in traoper

4、ative liver volumes were obta ined from a review of the patie nts' mediejl 慫&! of LDLT performed from Jan uary 2008 toLivi ng donor liver tran spla ntatio n (LDLT) has bee n used to alleviate the shortage of available liver donors. Accurate estimation of the standard liver volume (SLV) of th

5、e livi ng donor and recipie nt is crucial. Overestimati on of the donor ' s SLV may result in excessive hepatic resect ion lead ing to liver failure, while un derestimati on of the recipe nt' s SLV may result in small-for-size graftsyn drome1-5. Since 2001, our tran spla nt centers have carr

6、ied out 212 LDLTs. We estimated the SLV usi ng computed tomography (CT) or reported formulae.However, there was a differe nee betwee n these estimates and the actual liver volumes (ALVs) for Chin ese adults. Recen tly, we developed a new formula (n amed the Chengdu formula) to estimate SLV using dat

7、a from 115 LDLTsSthe formula is: SLV (mL) = 11.5x body weigh(kg) + 334. Using this formula, the SLVs were evaluatedZheng-Rong Shi, Lu-Nan Yan, Bo Li, Tian-Fu Wen,LiverTransplantation Division, Department of Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, ChinaAuth

8、or contributions:Shi ZR, Yan LN participated in theresearch design and writing of the paper; all authors participated in the performance of the research; Shi ZR contributed analytic tools and data analysis.Correspondence to: Lu-Nan Yan, MD, PhD,Liver Transplantation Division, Department of Surgery,

9、West ChinaHospital, Sichuan University, Chengdu 610041, Sichuan Province, China. yanlunan2009Telephone: +86-28-85422867 Fax: +86-28-85422867 Received: May 31,2009 Revised: July 16, 2009 Accepted: July 23, 2009Published online: August 28, 2009AbstractAIM: To evaluate different standard liver volume (

10、SLV) formula and verify the applicability of the formulae for Chi nese adults.RESULTS: The actual right liver volume was not signi?-cantly different from the estimated right liver volume determined by the Chen gdu formula, but was sig ni?ca ntlysmaller tha n estimates using the Hein ema nn, Urata, V

11、authey, and Lee formulae ( P < 0.01), and signi ?cantly larger tha n estimates using the Fan formula ( P < 0.05).CONCLUSION: The Che ngdu formula was dem on- strated to be reliable by its application in LDLT.? 2009 The WJG Press and Baishideng. All rights reserved.Key words: Standard liver vol

12、ume; Living donor liver tran spla ntati on; Chin ese adult; Liver volume formulaStrasse 3, 72076 T u bingen, Germany; Salvatore Gruttadauria,MD, Assistant Professor, Abdominal Transplant Surgery,ISMETT, Via E. Tricomi, 190127 Palermo, ItalyShi ZR, Yan LN, Li B, Wen TF. Evaluation of standard liver v

13、olume formulae for Chinese adults. World J Gastroenterol 2009; 15(32): 4062-4066 Available from: URL: http:/www. DOI: http:/dx.doi. org/10.3748/wjg.15.4062INTRODUCTIONApril 2009. Its accuracy was compared to that of other intern atio nally reported formulae 7-10 to assess which formula is the most a

14、ccurate for Chin ese adults.MATERIALS AND METHODSPatie nt select ionThe data from 76 liv ing donors were an alyzed. In clusi on criteria were: (1) a healthy adult donor, aged 19-59 years;(2) right liver graft without middle hepatic vein; (3) adult- to-adult LDLT; (4) single donor; (5) no history of

15、long term drinking. Exclusion criteria: (1) donor age < 18 or> 60 years; (2) left hepatic graft or left lateral lobe graft;double donor grafts; (4) adult-to-child tran spla nt; (5) donors who were hepatitis B or C carrier11-14.© 1 94-2010 China Academic Jutunal Eketrunic Publishing House.

16、 All ritihts reserved. hitp:f/www.enkLMCli ni cal dataPeer reviewers: Silvio Nadalin, MD, PhD, Director ofTransplant Program, Department of General, Visceral andTransplant Surgery, University Hospital Tu bingen, HoppeDSftalesf preoperative donors included age, sex, height© 1 94-2010 China Acade

17、mic Jutunal Eketrunic Publishing House. All ritihts reserved. hitp:f/www.enkLM4063Shi ZR et al. Liver volume formulae for Chinese adultsTable 1 Reported formulae for ESLVAuthorReport dateFormulaMaterial used (race, n umber)Urata et al71995ESLV = 706.2X BSA + 2.4CT Volumetry (Japa nese, 96)Hein ema n

18、n et al81999ESLV = 1072.8X BSA - 345.7Autopsy (Caucasian 1332)Vauthey et al92002LV = 18.51X BW + 191.8CT volumetry (Western, 292)Lee et al52006ESLV = 691X BSA + 95LDLT (Korea, 311)Fan et al42000ESLW = 218.32+BW x 12.29 + gen derLDLT (Chi nese, 159)50.74 (M = 1, F=0)Chengdu 62009ESLV = 334.024 + 11.5

19、08X BWLDLT (Chi nese, 115)ESLV: Estimated sta ndard liver volume; BSA: Body surface area; BW: Body weight; CT: Computed tomography; LDLT: Livi ng donor liver tran spla ntati on.© 1 94-2010 China Academic Jutunal Eketrunic Publishing House. All ritihts reserved. hitp:f/www.enkLM© 1 94-2010

20、China Academic Jutunal Eketrunic Publishing House. All ritihts reserved. hitp:f/www.enkLMTable 2 Donor characteristicsAge (yr)32.21± 10.07 (19-59)Gen der (Male:Female)53:17Body weight (kg)62.97± 8.41 (42-87)Body height (cm)167.31± 8.15 (148-185)Body mass index (kg/m2)22.23± 2.44B

21、ody surface area (m ) by DuBois formula1.7082± 0.142Body surface area (m ) by Mosteller formula1.7081± 0.14Total liver volume on CT (mL)1189.53± 114.75Right lobe graft volume on CT without MHV658.98± 81.14Right lobe volume without MHV to total liver55.4± 3.7volume on CT (%)A

22、ctual right liver volume (mL)578.58± 72.33MHV: Middle hepatic vein.(BH, measured to the nearest 1 cm), body weight (BW , measured to the n earest 0.5 kg), and body surface area (BSA) calculated usi ng the DuBois formula: BSA (m ) betwee n the ERLV and ARLV was statistically evaluated.The formul

23、ae ofHein ema nn et al，Urata et al，Vauthey et a弹，Lee et a5, and Fan et a4 i n additi on to6our own formula were used to determ ine the estimated SLV (ESLV) of our donor livers. The previously reported formulae are show n in Table 1. For each liver, we calculated the differe nee betwee n the ALV and

24、volume estimated by each formula (ELV).Statistical an alysisAfter test ing for no rmal distributi on (kurtosis and skew ness tests), descriptive statistics were calculated and data were expressed as means± SD for age (year), BW(kg), BH (cm), body mass index (BMI), and BSA. The ERLV-ARLV and the

25、 ELV-ALV were compared by the 2-sided paired-samples t-test. P < 0.05 was con sidered statistically significant. All statistical analyses were performed using the SPSS (vers ion 13.0) program.© 1 94-2010 China Academic Jutunal Eketrunic Publishing House. All ritihts reserved. hitp:f/www.enkL

26、Mx BH (cm) 0.725 x 0.007184 or therXrbSultsSeventy donors (all Chin ese; 53 men and 17 wome n; mean age, 32.21± 10.07; range, 19-57 years) met the selectio ncriteria. All donors were related to the recipie nts.The characteristics of donors are shown in Table 2. All donors were con sidered healt

27、hy on the basis of BMI. All but one donor with a BMI of 17 kg/m 2 had a BMI of 18-28 kg/m . The mean volume of the right lobe on CT was 658.98± 81.14 mL and represented 55.4%3.7% of the whole liver on CT.The mean ELV and mean ERLV using the Chen gdu standard formula were 1058.70± 96.74 mL

28、and 586.15± 67.17 mL, respectively. The mean ARLV was 578.58 ± 72.33 mL. Differe nces for in dividual donors betwee n ERLV and ARLV were not signi ?cant (t = -1.882, P = 0.064). A plot of the relationship of ARLV to the ERLV calculated using the Chen gdu formula is show n in Figure 1.The m

29、ean total LV determ ined preoperatively on CT was 1189.53± 114.75 mL. The mea n RLV on CTwithout the middle hepatic vein was 658.98± 81.14 mand 55.4%± 3.7% the total LV. The ALV calculatedfrom the volume of the graft and the ratio of the RLV to the total LV on CT (%) was 1050.10±

30、 107.41 mL.The Hein ema nn, Urata, Vauthey, and Lee formulae signi?cantly overestimated the LV ( P < 0.01), while the Fan formula sig ni fica ntly un derestimated the LV ( P <=BW (kg) 0.425:Mostellerformula: BSA (m2) = square root BH (cm) (kg)/3600. From the diaphragm to the superior mese nter

31、ic artery plane, the entire liver image was scanned using a 7 mm thick layer. In the Leonardo workstation, the LV was measured by venous phase imaged5,16. All preoperative CT exam in ati ons of donors were performed by a sin gle radiologist and all donor procedures were performed by the same surgica

32、l un it. The volume of the grafts was measured by a 3 L beaker using a dra in age method intraoperatively and the error was less than 10 mL®Right liver graft without middle hepatic vein recon struct ion from a livi ng donor was performed as described, with temporary occlusi on of the right port

33、al vein (PV) and right hepatic artery and use of ultras ono graphy to guide pare nchymal tran sect ion. The right hepatic duct, right hepatic artery, right portal vein bran ch, and right hepatic vein were tran sected approximately 2-3 mm from the con ?uence19,20, leaving the donor ' s main PV an

34、d con flue nee in tact. The graft was flushed with Uni versity of Wisc onsin soluti on through the PV and hepatic artery 21,22.The volume of 70 livers was calculated using the Chen gdu sta ndard LV formula as described above. The estimated right LV (ERLV) was obta ined by multipl ying the SLV by the

35、 proport ion of the LV con tributed by the right lobe on CT. The actual right LV (ARLV) was obta ined by in traoperative measureme nt. The differe nee© 1 94-2010 China Academic Jutunal Eketrunic Publishing House. All ritihts reserved. hitp:f/www.enkLM© 1 94-2010 China Academic Jutunal Eket

36、runic Publishing House. All ritihts reserved. hitp:f/www.enkLM4064 ISSN 1007-9327 CN 14-1219/R World J Gastroenterol August 28, 2009 Volume 15 Number 32vehruaFigure 1 Correlation between actual right liver volume (ARLV) and estimated right liver volume (ERLV) by the Chengdu formula.When both were th

37、e same, a dot would be on the linear line.70006509070flrar150 130 100o700090011LvA0000600300o700 L700100013001600ALVFormulamea l 士SDtP-valueUrata1208.73± 99.92-20.91P < 0.01Hein ema ll1486.85± 151.78-40.84P < 0.01Vauthey1357.40± 155.60-32.44P < 0.01Lee1275.36± 97.77-29.8

38、7P < 0.01Fan1034.28± 111.612.465P = 0.016Chengdu1058.70± 96.74-1.417P = 0.161ALV1050.10± 107.41NDNDTable 3 Statistical analysis of estimated LV by each formulaALV: Actual liver volume; ND: Not determined.61100nna menLeH30 1001oLvA005003001009700700900110013001500ALV0041Lccrenc80070

39、0o9000o100210031001700 800 900 1000 1100 1200 1300ALV© 194-2010 China A'CsKJcmie Juumul Eluctrunic PublishingAll rights rvstrvxd.ktlt© 194-2010 China A'CsKJcmie Juumul Eluctrunic PublishingAll rights rvstrvxd.ktltFigure 2 Correlation between actual liver volume (ALV) and estimated

40、liver volume (ELV) by each forWhen both were the same, a dot would be on the linear line. Formulae of Urata, Heinemann, Vauthey, and Lee overestimated LV with respect to ALV. The Fan formula underestimated LV and the Chengdu formula gave a good estimate of ALV.© 194-2010 China A'CsKJcmie Ju

41、umul Eluctrunic PublishingAll rights rvstrvxd.ktlt© 194-2010 China A'CsKJcmie Juumul Eluctrunic PublishingAll rights rvstrvxd.ktlt± 81.14 mL). The actTat Fan and Chengdu formulae were used to estimate ± 72.33 mV.ftorthCT LV or autopsy LV . Estimates of LV by CT were 5%-25% higher

42、than the ALV30.Statistical an alysis showed that the Fan formula tends to un derestimate LV. The weight and height of the donors in our study were higher tha n of those in the Hong Kong group. This may be one of the reasons both results are very close (Table 3). Above all, we believe that0.05). Ther

43、e was no sig ni?cant differe nee betwee n ALV and ELV using the Chen gdu formula (Figure 2).DISCUSSIONCT has become a sta ndard method for assess ing liver graft volume in living donors. Estimation of LV by CT (compared to actual volume) has a marg in of error of 5%-25%.In the prese nt study, all do

44、nors hadpreoperative CT assessme nt of LV (mean total LV189.53 ± 114.75 mL and mean volume of right lobe graft without middle hepatic vein, 658.98 volume of the right liver was 578.58 prese nt study, the LV on CT was 10%-20% higher than the ALV25-27. The reas ons may be as follows: (1) Preopera

45、tive CT measureme nt is carried out un der no rmal blood ?ow con diti ons. Perioperatively, liver resect ion in terrupts the blood supply caus ing a loss of liquid volume, collapse of support ing structures, and thereby reduct ion in the volume of the liver. (2) Sources of error (partial volume effe

46、ct, in ter-observer variati on, and respiratory moveme nts) may acco unt for this differe neg®The differe nee betwee n the ERLV (us ing our formula) and ARLV was compared to the differe nee betwee n ERLV, calculated using the formulae of Hein ema nn, Urata, Vauthey, Lee, and Fan, and ARLV in ou

47、r 70 donors. The Hein ema nn, Urata, Vauthey, and Lee formulae overestimated LV ( P < 0.01). The reasonsmay in clude: eth nic differe nces (patie nts in Europe and the Un ited States were Caucasia n). All except the Sheung© 194-2010 China A'CsKJcmie Juumul Eluctrunic PublishingAll rights

48、 rvstrvxd.ktlt4065Shi ZR et al. Liver volume formulae for Chinese adults© 1 94-2010 China Academic Jutunal Eketrunic Publishing House. All ritihts reserved. hitp:f/www.enkLM© 1 94-2010 China Academic Jutunal Eketrunic Publishing House. All ritihts reserved. hitp:f/www.enkLMBackgro undWith

49、development of living donor liver transplantation (LDLT), especially improvement of right graft adult-to-adult LDLT, the danger of donating has been paid more and more attention. The exact liver volume is not only relevant for10 the recipient, but also for the donor to avoid dangerous life-threateni

50、ng residual liver volumes.11 Research fron tiersScholars of different countries established several standard liver volume (SLV) formulae from clinical data. The authors estimated the SLV using computed tomography or reported formulae. However, there was a gap between these estimates and the actual l

51、iver volumes for Chinese adults. Recently, they 伐 developed a new formula (named the Chengdu formula) to estimate SLV using data from 115 LDLTs.Inno vati ons and breakthroughsWith the Chengdu formula, the SLVs were evaluated in 76 cases of LDLT performed from January 2008 to April 2009. Its accuracy

52、 was compared to that of other internationally reported formulae to assess which formula is the most accurate for Chinese adults.Applicati onsWith national multicenter data in the future, the Chengdu formula for SLV can be improved. It may then be applied to the evaluation of donors for LDLT. 14 Ter

53、mino logyStandard liver volume: normal liver volume without disease affecting the volume of liver.the Chen gdu formula was dem on strated to be reliable by its applicati on in LDLT. We were limited to use of sin gle cen ter data in the prese nt study, but we hope to improve the formula by using n at

54、i onal multice nter data in the future31.T, Ishizone S, Momose Y, Komiyama A, Makuuchi M. Calculation of child and adult standard liver volume for liver transplantation. Hepatology 1995; 21: 1317-1321 Heinemann A , Wischhusen F, Puschel K, Rogiers X. Standard liver volume in the Caucasian population

55、.LiverTranspl Surg 1999; 5: 366-368Vauthey JN , Abdalla EK, Doherty DA, Gertsch P, Fenstermacher MJ, Loyer EM, Lerut J, Materne R, Wang X, Encarnacion A, Herron D, Mathey C, Ferrari G, Charnsangavej C, Do KA, Denys A. Body surface area and body weight predict total liver volume in Western adults. Li

56、ver Transpl 2002; 8: 233-240Chan SC , Liu CL, Lo CM, Lam BK, Lee EW, Wong Y, Fan ST. Estimating liver weight of adults by body weight and gender. World J Gastroenterol 2006; 12: 2217-2222 Trotter JF , Wisniewski KA, Terrault NA, Everhart JE, Kinkhabwala M, Weinrieb RM, Fair JH, Fisher RA, Koffron AJ

57、, Saab S, Merion RM. Outcomes of donor evaluation in adult-to-adult living donor liver transplantation. Hepatology 2007; 46: 1476-1484Duran C , Aydinli B, Tokat Y, Yuzer Y, Kantarci M, Akgun M, Polat KY, Unal B, Killi R, Atamanalp SS. Stereological evaluation of liver volume in living donor liver transplantation using MDCT via the Cavalieri method.LiverTranspl 2007; 13: 693-698Morimoto T , Ichimiya M, Tanaka A, Ikai I, Y