肝切除术后第3天ICG-R15对肝细胞肝癌术后肝功能不全的预测价值

Value of ICG-R15 on postoperative day 3 in predicting liver dysfunction after hepatectomy for hepatocellular carcinoma

目的:探讨术后第3天吲哚菁绿15 min潴留率(ICG-R15)预测肝细胞肝癌术后肝功能不全发生的价值。方法:回顾2015年1月—2016年2月期间行肝切除的119例肝细胞肝癌患者资料,分析患者术后肝功能不全的发生与术前及术后第3天ICG-R15的关系,并比较术前与术后ICG-R15在预测术后肝功能不全发生的差异。结果:119例患者中共有33例(27.7%)术后发生肝功能不全。发生与未发生肝功能不全患者术前ICG-R15平均值分别为9.7%、5.2%,术后第3天ICG-R15平均值分别为11.8%、5.3%,术前与术后ICG-R15在发生与未发生肝功能不全患者间差异均有统计学意义(均P<0.05)。分层分析显示,术后肝功能不全的发生率均随术前或术后第3天的ICG-R15增加而升高,且均在ICG-R15<10%与>20%的患者间有明显统计学差异(均P<0.05)。术后第3天ICG-R15预测术后肝功能不全发生的ROC曲线下面积较术前ICG-R15大,前者的临界值为7.75(灵敏度为66.7%,特异度为83.7%),后者为3.35(灵敏度为84.8%,特异度为46.5%)。结论:术后第3天ICG-R15与术前ICG-R15一样可预测肝细胞肝癌术后肝功能不全的发生,且可能优于术前ICG-R15。

Objective： To investigate the value of indocyanine green retention test at 15 minutes （ICG-R15） on postoperative day （POD） 3 in predicting the occurrence of liver dysfunction atfer hepatectomy for hepatocellular carcinoma （HCC）. Methods： hTe clinical data of 119 HCC patients undergoing hepatectomy from January 2015 to February 2016 were reviewed. The relations of the occurrence of postoperative liver dysfunction with preoperative and POD 3 ICG-R15 were analyzed, and the difference in predicting the occurrence of postoperative liver dysfunctionnbsp;between preoperative and POD 3 ICG-R15 was also compared. Results： Postoperative liver dysfunction occurred in 33 （27.7%） of the 119 patients. In patients with and without liver dysfunction, the average preoperative ICG-R15 was 9.7% and 5.2%, and POD 3 ICG-R15 was 11.8% and 5.3% respectively, and either the preoperative or POD 3 ICG-R15 was signiifcantly different between patients with and without liver dysfunction （bothP〈0.05）. Results of stratiifed analysis showed that the incidence of postoperative liver dysfunction was increased with the elevation of either preoperative or POD 3 ICG-R15, with statistical difference noted between patients with ICG-R15〈10% and 〉20% （bothP＆lt;0.05）. hTe area under the curve of ROC of POD 3 ICG-R15 for prediction of preoperative liver dysfunction was larger than that of preoperative ICG-R15, and the cut-off value for the former was 7.75 （sensitivity： 66.7%; speciifcity： 83.7%） and for the latter was 3.35 （sensitivity： 84.8%; speciifcity： 46.5%）, respectively. Conclusion： POD 3 ICG-R15 can be used for predicting liver dysfunction atfer hepatectomy for HCC similar to that of preoperative ICG-R15, and may even be superior to the latter.