Cho JY, Suh KS, Kwon CH, Yi NJ, Lee KU.
首尔大学医学院，首尔，韩国

背景：目前我们对肝切除术后肝脏的再生能力和脂肪肝的手术风险了解得尚不是很清楚。我们评估了捐赠者在肝脏切除后的再生能力和脂肪肝的疗效。

方法：我们使用容量分析、肝脾摄取比值、肝衰减指数等，对2002年9月至2003年12月期间进行活体肝移植的连续54例捐赠者进行了前瞻性的分析。后者表明计算机断层扫描（CT）与组织学脂肪变性有很大的关系。我们对捐赠者进行了至少1年的随访（460—915天），并且根据大泡性脂肪病变的病理程度将患者分为：第一组，<5% (n = 36)；第二组，5%-30% (n = 18)。

结果：研究过程中没有发生死亡或肝功能衰竭事件，并且没有捐赠者需要再次手术或手术中输血。两组患者一系列的肝功能检查结果、最大和最小发病率都很相似。在第一组中，患者术后的肝脾摄取比值和肝衰减指数都保持在正常值范围之内的恒定水准，第二组患者则比正常值要高出很多。两组患者在肝切除术后十天内的肝脏再生率没有差别（P=.487），但第一组患者在肝切除术后三个月的肝脏再生率则略高于第二组（P < .044）。然而，两组患者在肝切除术后一年的肝脏再生率没有差别（P=.4）。

结论：肝切除术能够立即清理轻度脂肪肝，同时早期再生能力受损，但是长期再生能力却不受影响。因此，有轻度脂肪肝的患者能够进行肝切除术，且发病率很低。

Mild hepatic steatosis is not a major risk factor for hepatectomy and regenerative power is not impaired
Cho JY, Suh KS, Kwon CH, Yi NJ, Lee KU.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

BACKGROUND: An understanding of the regeneration power and operative risk of steatotic livers after hepatectomy is still unclear. We evaluated the volume regeneration and outcome of steatotic livers after donor hepatectomy.

METHODS: Fifty-four, consecutive living liver donors from September 2002 to December 2003 were evaluated prospectively by volumetric analysis, liver-spleen ratio, and liver attenuation index; the latter has been shown by serial computed tomographic scanning to be correlated strongly with histologic steatosis. Donors were followed up completely for at least 1 year (460-915 days) and were allocated according to histologic degree of macrovesicular steatosis: group 1, <5% (n = 36); group 2, 5%-30% (n = 18).

RESULTS: No mortality or hepatic failure was observed, and no donor required reoperation or intraoperative transfusion. The results of serial liver function tests, and major and minor morbidities were comparable between groups. Liver-spleen ratio and liver attenuation index remained at a constant level above normal values postoperatively in group 1, but increased rapidly above normal values in group 2. No difference in the rate of liver regeneration at 10 days after hepatectomy was found between the groups (P = .487), but the liver regeneration rate at 3 months after hepatectomy in group 1 was slightly higher than that in group 2 (P < .044). However, no difference was observed between the 2 groups at 1 year after hepatectomy (P = .4).

CONCLUSIONS: Mild hepatic steatosis is cleared immediately after hepatectomy, and early regeneration power is impaired, but the long-term regenerative power is comparable. Hepatectomy in donors with mild steatosis can be performed with low morbidity.

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