结合吲哚氰绿清除试验的决策树评估肝癌切除术患者肝储备功能临床应用

Appling of decision tree incorporating indocyanine green clearance test in assessment of hepatic reserve for indication of hepatic resection in patients with hepatocellular carcinoma

目的:探讨结合吲哚菁绿(indocyanine green,ICG)清除试验的决策树评估肝癌肝部分切除术患者肝脏储备功能的临床应用价值。方法:选取2009年2月至2010年7月在南京医科大学第一附属医院肝脏外科手术切除的肝细胞肝癌患者82例,评估腹水并检测吲哚氰绿15 min储留率(ICGR-15)及总胆红素,探讨东京大学肝胆胰外科建立的一个基于上述三个变量的决策树评估肝部分切除术的安全性。结果:本组病例中通过术后病理证实为肝细胞肝癌的82例患者,严格遵照东京大学肝胆胰外科制定的结合吲哚氰绿清除试验的决策树行肝部分切除术后无重大并发症及再次手术,所有患者术后无1例发生肝功能衰竭及手术后死亡,术后均安全出院。结论:结合吲哚氰绿清除试验的决策树能够准确评估肝部分切除患者的肝储备功能状况,对避免患者术后发生肝功能衰竭有重要的临床指导作用。

Objective： To investigate the efficacy of decision tree incorporated with indocyanine green clearance test on hepatic reserve function in patients with hepatocellular carcinoma.Methods：Eighty-two patients with hepatocellular carcinoma confirmed by pathology were enrolled.The presence of ascites,serum bilirubin level and indocyanine green retention rate at 15 minutes were elevated.Results：During strict application of this decision tree to 82 hepatectomies,no postoperative mortality（overall morbidity of 0%） and no major complications were observed.Conclusion：The decision tree can provide more precise information of liver function so as to avoid liver failure of patients with hepatocellular carcinoma.