肝脏储备功能评价对巨大肝脏肿瘤解剖切除的应用价值

The value of liver functional reserve estimation in large liver cancer anatomic resection

手术切除是肝脏肿瘤获得根治性疗效的主要手段。但切除肿瘤(特别是巨大肿瘤)后,若剩余肝脏储备功能不足,术后易发生肝功能衰竭,这也是肝外科围手术期死亡的重要原因。因此,准确评估病人术前肝脏储备功能,对病人能否耐受手术、判断术中肝脏切除范围、避免术后出现肝功能衰竭具有重要意义。目前评价肝脏储备功能的主要方法:基于血清(浆)学的肝脏功能动态检测如吲哚氰绿(ICG)试验、单乙基甘氨酸二甲苯胺(MEGX)试验等;系统评分如Child-Pugh评分等;以及肝脏体积测定。术后肝功能恢复取决于剩余肝脏的体积、质量及病人全身情况等多方面。因此,术前要结合多项指标全面、准确、综合评估肝脏储备功能。

Liver resection is the main curative treatment for liver tumors. It is susceptible to complicate with postoperative liver failure （PLF） which is a major reason of perioperative death after tumor especially large tumor resection if functional reserve of residual liver is insufficient. Thus, it is important to precise preoperative liver functional reserve estimation to determine if patients tolerate liver resection size to avoid PLF. Currently there are three ways to estimate liver functional reserve before surgery： Dynamic liver function test such as Indocyanine Green Clearance （IGC） test and Monoethylglycinexylidide （MEGX） test; Clinical stagingsystem such as Child-Pugh score; liver volume estimation. Since the recovery of liver function depends on residual liver volume, residual liver quality and the general condition of patients, it＇ s necessary to combine results from different tests to make the preoperative assessment comprehensive and accurate.