吲哚菁绿试验对贲门周围血管离断术并脾脏切除术的风险评估

Risk assessment of indocyanine green test for pericardia vascularization and splenectomy

目的探讨吲哚菁绿试验在门静脉高压症并发上消化道出血的患者中行脾切断流术中的应用价值。方法收集并分析2019年7月至2021年7月郑州市中心医院43例行吲哚菁绿试验并行脾切断流术的门静脉高压症并发上消化道出血患者的临床资料,评估吲哚菁绿试验15min留滞率(ICG-R15)对于围手术期出现肝功能不全的价值。结果术后肝功能代偿组ICG-R15滞留时间为(13.75±3.263)min、Child-Pugh分值为(6.61±1.40)与肝功能不全组的ICG-R15滞留时间为(19.86±6.362)min、Child-Pugh分值为(7.86±0.90)对比,两组之间的差异有统计学意义(P<0.05)。术后是否出现肝功能不全对ICG-R15滞留率和Child-Pugh分级分别进行χ^(2)检验,两组之间差异有统计学意义(P<0.05)。ICG-R15对于评估术后出现肝功能不全的敏感性为85.7%,特异性为69.4%。ICG-R15和Child-Pugh分级呈显著正相关(P<0.01)。结论ICG-R15在评估肝脏储备功能中可以作为敏感指标,ICG-R15结合Child-Pugh分级可以很好的评估肝脏储备功能,并能增加预测围手术期出现肝功能不全的准确性。

Objective To investigate the application value of indolyanine green test in splenotomy for patients with portal hypertension complicated with upper gastrointestinal bleeding.Methods The clinical data of 43 patients with portal hypertension complicated by upper gastrointestinal bleeding who underwent indocyanine green test and splenectomy in our hospital from July 2019 to July 2021 were collected and analyzed,and the 15-min retention of indocyanine green test was evaluated.The value of perioperative hepatic insufficiency(ICG-R15)was evaluated.Results The retention time of ICG-R15 in the postoperative liver function compensation group was(13.75±3.263)min,the Child-Pugh score was(6.61±1.40),and the retention time of ICG-R15 in the liver dysfunction group was(19.86±6.362)min,and the Child-Pugh score was(7.86±0.90),the difference between the two groups was statistically significant(P<0.05).Whether there was hepatic insufficiency after operation was performed byχ^(2)test for ICG-R15 retention rate and Child-Pugh classification respectively,and the difference between the two groups was statistically significant(P<0.05).The sensitivity and specificity of ICG-R15 for evaluating postoperative hepatic insufficiency were 85.7%and 69.4%respectively.There was a significant positive correlation between ICG-R15 and Child-pugh grading(P<0.01).Conclusion ICG-R15 can be used as a sensitive index in the evaluation of liver reserve function.ICG-R15 combined with child-Pugh grading can effectively evaluate liver reserve function,and can increase the accuracy of predicting liver insufficiency during perioperative period.