肝细胞癌术前肝储备功能评估方法的研究进展

Advances in preoperative assessment of liver functional reserve in patients with hepatocellular carcinoma

目的介绍肝储备功能常用评估方法的基本原理,同时比较各种评估方法的优缺点,为肝细胞癌患者能否手术治疗提供参考。方法对肝细胞癌患者肝储备功能评估方法相关研究的文献进行综述。结果从文献综述的结果看,Child-Pugh评分分级和吲哚菁绿清除试验是目前临床上肝细胞癌患者最常被使用的术前肝储备功能评估方法,白蛋白-胆红素分级、钆塞酸二钠增强磁共振成像等方法在预测肝切除术后肝衰竭方面的价值正在逐步被发掘。结论肝细胞癌术前肝储备功能评估目前主要依靠临床参数与体积测量相结合,核医学和钆塞酸二钠增强磁共振成像的临床应用弥补了局部肝储备功能评估的缺陷,可能是未来转化治疗后评估肝储备功能的重要方法,但仍需更多的国内研究来证实其价值。

Objective To introduce the basic principles of commonly used assessment methods for liver function reserve,and compare the advantages and disadvantages of various assessment methods,so as to provide a reference for hepatectomy of patients with hepatocellular carcinoma(HCC).Method The literature on evaluation methods of liver reserve function in patients with HCC at home and abroad in recent years was searched and summarized.Results From the results of literature review,the Child-Pugh score and indocyanine green discharge test were the most commonly used to assess preoperative liver function reserve for patients with HCC.The application value of other examinations such as albumin-bilirubin score,gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(Gd-EOB-DTPA-enhanced MRI),nuclear medical imaging in predicting post-hepatectomy liver failure was gradually being explored.Conclusions The combination of clinical parameters and volumetric studies is used to assess preoperative liver function reserve for patients with HCC.The clinical applications of nuclear medical imaging and Gd-EOB-DTPA-enhanced MRI make up for the deficiency of local liver function reserve evaluation,which are important examinations to assess liver function reserve after conversion therapy in the future.However,more domestic studies are still needed to confirm their values.