| Objective: To investigate the correlation between CT and displacement method during the operation in the measurement of liver volume for pediatric living donor liver transplantation and analysis the correlation between CT angiography and intraoperative exploration in the classification of anatomical variation of hepatic artery,portal vein and hepatic vein.Materials and methods: From October 2017 to December 2019,53 cases of pediatric living donor liver transplantation for children in the First Affiliated Hospital of Guangxi Medical University were selected.The clinical data was complete and there was no liver malignant tumor.CTA of the upper abdomen were performed in our hospital before operation,and the hepatic vessels were clearly displayed.Before operation,the liver volume was measured by Ziostation post-processing workstation to get the volume of the planned transplanted liver segment,which was compared with that measured by displacement method during the operation.Volume rendering(VR),maximum density projection(MIP)and 3D reconstruction of CT angiography images were observed.And the types of hepatic artery,portal vein and hepatic vein were recorded and compared with the results of intraoperative exploration.Paired t-test was used to analyze the volume of transplanted liver with CT and intraoperative drainage.Comparison of CT angiography and intraoperative exploration in the classification of hepatic vessels was taken by kappa test.Results: There was no significant difference between preoperative CT volume(255.15±63.67)ml and intraoperative drainage volume(259.66 ±55.59)ml(P ?0.05).The normal type of hepatic artery accounted for 60.4%(32 / 53),and 21 cases had hepatic artery variation which accounted for 39.6%(21 / 53)in CT.While the normal type of intraoperative exploration accounted for 58.5%(31 / 53),and the variation was 41.5%(22 / 53).According to kappa consistency analysis,the kappa value was 0.938.CT evaluation of the portal vein showed that the common type accounted for 79.3%(42/53),and 11 cases had portal vein variation,accounting for 20.8%(11 / 53).While the common type accounted for 77.4%(41 / 53)and the variation was22.6%(22/53)in intraoperative exploration.The kappa value was 0.832.CT evaluation of hepatic vein type I accounted for 81.1%(43/53),type ? 17.0%(9/ 53),type ? 1.9%(1 / 53).While in intraoperative exploration the rate of type I was 75.5%(40 / 53),type ? 20.8%(11 / 53),type ? 3.8%(2/53).And the kappa value was 0.849.Conclusion: CT measurement of liver volume can accurately evaluate the volume of transplanted liver segment before liver transplantation,and CT angiography can be used in preoperative evaluation of liver transplantation to classify hepatic artery,portal vein and hepatic vein,which plays an important role in guiding liver transplantation.Objective: To analyze the trend of recipient's liver regeneration in one year after pediatric living donor liver transplantation and the correlation between the recipient's age,donor's age,GRWR,PELD score,spleen volume and liver regeneration rate at different time after transplantation.and to study the impact on the liver in children multivariate analysis of liver regeneration rate at different time points after transplant recipient.Materials and methods: From January 2017 to January 2020,patients with end-stage liver disease ?12 years old who were admitted to the First Affiliated Hospital of Guangxi Medical University and qualified for liver transplantation were selected.The patient's clinical data was complete.The volume of transplanted liver was measured by drainage during operation,and the CT of upper abdomen was performed in our hospital in different time periods(one month,three months,six months and twelve months).The clinical data of 47 patients were collected,including sex,age,height,weight,TBIL,ALB,INR,and PELD score.Liver volume data included intraoperative measurement of graft weight(GW)and calculated graft-to-recipient weight ratio(GRWR).Record the intraoperative liver volume and the graft volume(GV)after transplantation at different time,calculate regeneration rate.One-way ANOVA was applied to the comparison of multiple sets of data,Pearson or Spearman correlation test was used for correlation analysis,stepwise regression analysis was used for of multivariate regression analysis.Results: The LRR of children liver transplant recipients in one month,three months,six months and twelve months were 47.76 ± 36.83%,58.78 ± 66.53%,60.51 ± 44.25%,78.06 ± 61.27% respectively,and the LRR gradually increased after surgery.There was no significant difference in LRR.There was a positive correlation between the age of recipient and LRR at one month and three months after operation(P ? 0.05),the older the recipient,the higher the postoperative LRR.There was a negative correlation between GRWR and LRR in three months,six months and twelve months(P ? 0.05).The larger GRWR,the lower LRR.There was no correlation between donor age,PELD score,spleen volume and LRR.The results of multivariate analysis showed that GRWR was an independent factor of LRR in three months,six months and twelve months.Conclusion: Rapid growth of liver volume in pediatric living donor liver transplantation recipients in one month after transplantation,liver regeneration tended to be stable from one month to one year after transplantation.The older the recipient,the faster the early liver regeneration,the larger the GRWR,and the slower the liver regeneration. |
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