原发性肝癌患者术前肝储备功能的预测和术后评价

EVALUATION OF LIVER RESERVE FUNCTION PRE-OPERATION AND POST-OPERATION FOR THE PATIENTS WITH PRIMARY LIVER CARCINOMA

目的运用脉动色素浓度法(PDD)测定吲哚氰绿潴留率(ICGR15)及有效肝脏血流量(EHBF)评估原发性肝癌患者术前肝脏的储备功能。方法对55例原发性肝癌患者术前应用PDD法检测ICGR15和EHBF并根据ICGR15分为3组,并行Ch ild-Pugh评分;根据术后肝功的恢复情况将患者分为肝功能恢复良好(G)、轻度不全(M)和重度不全组(S)。分析ICGR15三组中术后肝功不全的发生率以及在不同肝功恢复组中ICGR15、EHBF与Ch ild-Pugh评分比较。结果术后肝功不全在ICGR15三组中的发生率差异具有统计学意义(P<0.05);肝功恢复不同组间ICGR15、EHBF同Ch ild-Pugh评分比较具有显著性差异(P>0.05);在不同的Ch ild-Pugh分级之间,ICGR15及EHBF值差异有统计学意义(P<0.05)。结论ICGR15、EHBF比传统Ch ild-Pugh评分可以更准确的评估肝储备功能并指导确定手术方案。

Objective To investigate retention rate of indocyanine green at fifteen minutes （ICGR15） and effective hepatic blood flow （EHBF） by using pulse dye densitometry（PDD） method to evaluate liver reserve function in patients with primary liver carcinoma before operation. Method Before operation all the patients was tested with ICGR15 and EHBF by PDD method. Based on the ICGR15, all patients were divided into three groups ,and meanwhile Child-Pugh classification were also tested. After operation, all those patients were divided into three groups according to liver function conditions including G. M and S Groups. The incidence of hepatic failure postsurgically in the three groups with ICGR15 test were analyzed, Child-Pugh classification, ICGR15, EHBF were compared among G, M, S groups. Results The incidence of liver dysfunction were significantly different in the three groups with ICGR15 test postsurgically（P 〈 0. 05）. The levels of ICGR15 and EHBF were compared to the Child-Pugh classifications showed statistical differences among G, S, M groups（ P 〈 0. 05 ）. ICGR15 and EHBF were significantly differences in different Child-Pugh classification （P 〈 0. 05 ）. Conclusion ICGR15 and EHBF may be more precisely compared to the Child-Pugh classification in evaluation liver reserve function for the patients with primary liver carcinoma and can guide plan of operation.