术前肝储备功能评估对原发性肝癌手术的价值

PREOPERATIVE EVALUATION OF HEPATIC FUNCTIONAL RESERVE FOR PATIENTS WITH PRIMARY LIVER CARCINOMA

为评估原发性肝癌患者肝储备功能，对１２２例经剖腹探查的肝癌病人作术前检测吲哚靛青绿１５ｍｉｎ潴留率（ＩＣＧＲ１５）及常规肝功能试验。根据术后肝功能代偿情况分为三组：肝功能代偿良好组８７例，轻度不全组２４例，重度不全组１１例。术前按Ｐｕｇｈ评分，三组之间评分值差异无显著性意义；其它常规肝功能检查项目包括谷丙转氨酶、γ－谷氨酰转肽酶及碱性磷酸酶，三组值差异亦无显著性意义；ＩＣＧＲ１５值三组差异有非常显著性意义。作者根据ＬＧＲ１５值分为Ａ、Ｂ、Ｃ三组，Ａ组ＩＣＧＲ１５＜１０．０％；Ｂ组ＩＣＧＲ１５为１０．０％～２０．０％，Ｃ组ＩＣＧＲ１５＞２０．０／。三组肝功能不全发生率分别为６．５％、２７．８％及７６．５％，其差异有非常显著性意义。结果表明：ＩＣＧＲ１５值越高，术后肝功能代偿不全发生率亦越高，提示ＩＣＧＲ１５是评估肝癌患者术前肝储备功能较好的指标。

Abstract The retention rate of indocyanine green at 15 minutes(ICGR15)and routine hepatic functiontests were performed preoperatively in 122 cases of patients with primary liver carcinomas in or-der to evaluate the hepatic functional reserve. These patients were divided into 3 groups accordingto the post-operative changes of hepatic function. 87,24 and 11 cases showed good recovery(group good),mild liver dysfunction(group mild ) and severe liver dysfunction(group severe)respectively,after operation. The differences of Pugh’s points, ALT , ALP and γ-GT betweeneach two groups were not significant.But,the differences of ICGR15 were very significant.Wealso divided all cases into 3 groups according to the value of ICGR15.The incidence of liver dys-function was 6.0%in group A(ICGR15<10.0%),27.8%in group B(ICGBR1=10.0%～20.0%)and 76.5%in group C(ICGR15 >20.0%),respectively. The difference of the inci-dences of liver dysfunction in these 3 groups was very significant.The higher the ICGR15,themore the incidence of liver dysfunction. These results demonstrated that ICGR15 is a good indica-tor to judge hepatic functional reserve for patients with primary liver carcinoma.