吲哚氰绿排泄试验及标准余肝体积与肝癌切除术后肝功能不全的相关性研究

Combined indocyanine green test and standard remnant liver volume to predict post-hepatectomy hepatic insufficiency for the patients with hepatocellular carcinoma

目的结合吲哚氰绿（ICG）排泄试验及标准余肝体积探讨预防肝切除术后肝功能中、重度代偿不全的安全切肝界限。方法对2007年3月至2008年2月期间收治的75例因肝癌行肝切除术的患者进行研究分析，根据术后肝功能代偿状况分组，将术后发生肝功能中度代偿不全患者术前ICG 15min潴留率（ICGR15）值与术后标准余肝体积进行直线回归分析。结果全部患者中，术后发生肝功能轻度代偿不全60例，中度代偿不全12例，重度代偿不全3例。轻度代偿不全组与中重度代偿不全组患者的年龄[（50±13）岁和（53±9）岁]、术前Child—Pugh评分[（5．4±0．6）分和（5．7±0．9）分]、凝血酶原时间[（13．6±1．0）s和（13．5±1．0）s]、国际标准化比值（1．09±0．10和1．06±0．10）等指标的差异均无统计学意义（P〉0．05）；而两组ICG排泄试验中的K值（0．20±0．04和0．17±0．03）和ICGR15值（6±4和9±4）以及术后标准余肝体积[（545±93）ml和（398±82）ml]的差异均有统计学意义（P〈0．05）。将术后肝功能中度代偿不全患者术前ICGR15值和术后标准余肝体积进行直线回归分析，发现两者呈正相关（R=0．640，P=0．025），回归方程为：标准余肝体积（ml／m^2）=1594．6×ICGR15＋265。结论将ICG排泄试验和标准余肝体积结合起来评估患者肝脏储备功能，有助于预测患者术后发生肝功能损害的程度及预防患者术后发生肝功能中、重度代偿不全。

Objective To discuss the safety line to avoid the post-hepateetomy hepatic insufficiency by combining indoeyanine green test by pulse dye-densitometry （PDD-ICG） and standard remnant liver volume （SRLV）. Methods Seventy-five hepatic cancer patients undergone hepateetomy from March 2007 to February 2008 were included. According to the liver function deeompensatory grades after operation, the relationship between ICG retention rate at 15 rain （ICGR15） and standard remnant liver volume by linear regression were analyzed. Results There were 60 eases with slight hepatic insufficiency, 12 eases with moderate hepatic insufficiency, and 3 eases with severe hepatic insuffleiency. There were no difference in age [ （50 ±13） years old and（53 ± 9） years old] ,prothrombin time[ （ 13.6 ±1.0） s and（ 13.5 ± 1. 0） s], international normalized ratio（ 1.09 ±0. 10 and 1.06 _＋ 0. 10） between slight hepatic insufficiency group and moderate and severe hepatic insufficiency group （P 〉 0. 05 ）. And there were difference in K value （0. 20±0. 04 and 0. 17 ±0. 03） ,ICGR15（6±4 and 9±4） ,SRLV[ （545±93） ml and （398±82） roll between two groups （ P 〈 0. 05 ）. Compared ICG test and standard remnant liver volume of the patients with moderate hepatic insufficiency after operation, the liner relationship was found （ R = 0. 640, P = 0.025 ） , and the regression equation was ：standard remnant liver volume （ nl/m^2 ） ： 1594. 6 × ICGR15 ＋ 265. Conclusions PDD-ICG test and standard remnant liver volume are effective to estimate hepatic function reserve of patient undergone hepateetomy.