肝癌术前ICG_(R15)测定对肝脏储备功能的评估

Evaluation of Liver Reserve Function by ICGR15 Detection before Hepatectomy for Hepatocellular Carcinoma

背景与目的:术前正确评估肝脏储备功能,是避免肝癌患者术后肝功能衰竭的重要措施。近年来,吲哚靛青绿储留率(indocyaninegreenretentionrateat15min,ICGR15)被认为能准确而灵敏地反映肝脏储备功能。本研究目的探讨肝癌切除术前ICGR15在评估肝硬化程度和肝脏储备功能中的作用,分析ICGR15与术后肝功能不全的关系,并与Child-Pugh分级进行比较。方法:分析225例手术切除的肝细胞癌患者术前常规肝功能检查、Child-Pugh分级及ICGR15的测定结果。结果:肝硬化患者及无肝硬化患者ICGR15均值分别为(9.90±6.20)%、(7.41±3.80)%,差异有显著性(P<0.01);轻、中、重度肝硬化患者的ICGR15均值分别为(8.49±5.00)%、(10.70±5.70)%、(15.77±9.60)%,三组间两两比较差异有显著性(P<0.05);术后发生腹水、黄疸患者的ICGR15均值分别为(11.49±6.80)%、(12.09±7.10)%,分别显著高于无腹水、无黄疸患者(8.53±4.90)%、(8.96±5.30)%(P<0.05)。将可能影响术后并发症发生的多种因素以enter法引入多元logistic回归模型,ICGR15对术后发生腹水、黄疸均有显著影响(P<0.05)。Child-PughB级患者的ICGR15均值为(15.25±8.60)%,显著高于Child-PughA级患者(8.85±5.10)%(P<0.01);212例Child-PughA级患者中有67例ICGR15大于10%。

BACKGROUND &OBJECTIVE: Accurate estimation of liver reserve functi on before hepatectomy for liver cancer may avoid postoperative liver failure. Re cently, it has been considered that indocyanine green retention rate at 15 minut es (ICGR15) can assess liver reserve function with exactitude and high sensitivi ty. This study was to discuss the evaluation of liver cirrhosis severity and liv er reverse function by ICGR15, analyze the relationship between ICGR15 and post-operative liver failure,and compare ICGR15 with Child-Pugh grading. METHODS: Records of 225 patients with resected hepatocellular carcinoma (HCC) have been c ollected. Pre-operative data,such as a variety of routine liver biochemistry te sts, Child-Pugh grading,and ICGR15 value, and intra-operative data,post-opera tive data were analyzed. RESULTS: The mean value of ICGR15 was (9.9±6.2)%in ci rrhosis group, and (7.4±3.8)%in non-cirrhosis group (P< 0.01). The mean value of ICGR15 was (8.5±5.0)%in mild cirrhosis subgroup,(10.7±5.7)%in moderate c irrhosis subgroup, and (15.8±9.6)%in severe cirrhosis subgroup; significant di fferences can be observed while multiple comparisons were performed (P< 0.05). T he mean values of ICGR15 in patients who suffered from post-operative ascites, and jaundice were (11.5±6.8)%, and (12.1±7.1)%; significantly higher than th ose without ascites, and jaundice [(8.5±4.9)%, and (9.0±5.3)%] (P< 0.05). Po ssible predictor variables indicating risk factors of post-operative complicati ons were entered into a multiple logistic regression model, the results showed t hat ICGR15 significantly affected the occurrence of both post-operative ascites and jaundice (P< 0.05). The mean value of ICGR15 of patients of Child-Pugh B g rade was (15.2±8.6)%, much higher than that of patients of Child-Pugh A grade [(8.8±5.1)%](P< 0.01). ICGR15 values were above 10%in 67 of the 212 patients of Child-Pugh A grade, and 6 of these 67 patients have a value above 20%. CON CLUSIONS: ICGR15 value rises with the aggravation of liver cirrhosis, it affects the occurrence of post-operative liver failure significantly. Some correlation can be observed between ICGR15 and Child-Pugh grading.