原发性肝癌合并肝硬化患者半切除术临界值对术后肝衰竭的预测价值

Predictive Value of Hemicolectomy Thresholds for Postoperative Liver Failure in Patients with Primary Liver Cancer Combined with Cirrhosis

目的:分析原发性肝癌(PLC)合并肝硬化患者半切除术临界值对术后肝衰竭的预测价值。方法:回顾性分析2018年6月—2020年6月焦作市第二人民医院收治的110例PLC合并肝硬化患者。术前和术后5 d采用吲哚菁绿(ICG)清除试验15 min血清中ICG滞留率(ICGR15)试验,测定ICGR15值。术后统计肝衰竭发生情况。分析术前ICGR15值(≤10%、10%~20%、≥20%)与术后肝功能衰竭发生情况、不同手术方式与术前ICGR15值、术后肝功能衰竭发生情况、术后肝衰竭ICGR15值临界值,并分析临界值与不同手术方式术后肝功能衰竭发生情况。结果:ICGR15值10%~20%肝功能衰竭发生率显著高于≥20%、≤10%,差异有统计学意义(χ^(2)=25.164,P<0.05);术前ICGR15值≤10%、10%~20%、≥20%不规则局部肝半切除、半肝及扩大半肝切除术后肝衰竭发生,差异有统计学意义(χ^(2)=7.011、19.662,P<0.05);ICGR15临界值≤6.09%肝衰竭发生率低于>6.09%,差异有统计学意义(χ^(2)=14.572,P<0.05);ICGR15值≤6.09%不规则局部肝半切除术后肝衰竭发生率高于>6.09%,差异有统计学意义(χ^(2)=7.766、0.672,P<0.05)结论:原发性肝癌合并肝硬化患者半切除术ICGR15临界值检测有助于预测术后肝功能发生风险。

Objective:To analyze the predictive value of hemicolectomy thresholds for postoperative liver failure in patients with primary liver cancer(PLC) combined with cirrhosis.Methods:The data of 110 patients with PLC combined with cirrhosis admitted to the hospital from June 2018 to June 2020 were retrospectively analyzed. ICGR15 values were measured preoperatively and 5 d postoperatively using the indocyanine green(ICG) clearance test 15 min ICG retention rate in serum(ICGR15) test. The occurrence of postoperative liver failure was counted. Preoperative ICGR15 values(≤10%, 10%-20%, ≥20%) and the occurrence of postoperative liver failure, different surgical procedures and preoperative ICGR15 values, the occurrence of postoperative liver failure, and the critical values of postoperative liver failure ICGR15 values were analyzed, and the critical values and the occurrence of postoperative liver failure by different surgical procedures were analyzed.Results:The incidence of hepatic failure was significantly higher in ICGR15 values 10%-20% than in ≥20% and ≤10%, with a statistically significant difference(χ^(2)=25.164, P<0.05). There was a statistically significant difference in the incidence of liver failure after preoperative ICGR15values ≤10%, 10% to 20%, and ≥20% irregular partial hepatic hemicolectomy, hemicolectomy and extended hemicolectomy(χ^(2)=7.011, 19.662, P<0.05). The incidence of liver failure with ICGR15 threshold ≤6.09% was lower than that of >6.09%, with a statistically significant difference(χ^(2)=14.572, P<0.05). The incidence of liver failure after irregular partial hepatectomy with ICGR15 values ≤6.09% was higher than>6.09%, with a statistically significant difference(χ^(2)=7.766, 0.672, P<0.05).Conclusion:ICGR15 threshold test for hemicolectomy in patients with primary liver cancer combined with cirrhosis helps predict the risk of postoperative liver function.