The present letter to the editor is in response to the research“Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis”by Elshaarawy et al in World J Gastroenterol 2021;13(5):42...The present letter to the editor is in response to the research“Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis”by Elshaarawy et al in World J Gastroenterol 2021;13(5):424–439.The preoperative assessment of the liver reserve function in hepatocellular carcinoma(HCC)patients with cirrhosis is crucial,and there is no universal consensus on how to assess it.Based on a retrospective study,Elshaarawy et al investigated the impact of various classical clinical indicators on liver failure and the prognosis after hepatectomy in HCC patients with cirrhosis.We recommend that we should strive to explore new appraisal indicators,such as the indocyanine green retention rate at 15 min.展开更多
文摘目的探讨肝储备功能对肝硬化食管静脉曲张破裂出血（esophageal varices bleeding，EVB）风险及预后的评估价值。方法回顾性分析笔者医院2009年9月～2012年2月收住的283例肝硬化食管静脉曲张患者的临床资料。根据入院时有无合并EVB分为出血组（n=168）和非出血组（n=115），比较两组人院当时肝储备功能评估结果，以多因素Logistic回归模型寻找肝硬化并发EVB的危险因素，并对经药物或手术控制出血后的患者随访观察1年，分析不同程度肝储备功能及入院后治疗方式对EVB患者预后的影响。结果出血组的肝储备功能相关因素中总胆固醇、纤维蛋白原均低于非出血组。而吲哚菁绿15分钟滞留率（indocyanine green retention rate at 15 minutes，ICG—R15）、门静脉宽度及脾脏厚度均高于非出血组，差异有统计学意义（P〈0．05），上述结果经Logistic回归分析得出总胆固醇、纤维蛋白原、ICG—R15、脾脏厚度是食管静脉曲张破裂出血的独立危险因素，OR值分别为0．561、0．643、1．022、1．045。在分别给予药物及手术治疗的两个治疗组中。ICG—R15在再出血患者及非再出血患者之间有统计学差异（P〈0．05），总胆固醇、纤维蛋白原、脾脏厚度在两者之间无统计学差异（P〉0．05）。两组1年内再出血率随着ICG—R15程度的上升而增加，同等程度ICG—R15水平，药物治疗组的再出血率大于手术治疗组。结论总胆固醇、纤维蛋白原、ICG—R15、脾脏厚度是肝硬化食管静脉曲张破裂出血的独立危险因素。EVB患者1年内的再出血率随ICG—R15增大而增加，手术治疗组的再出血率低于药物治疗组，EVB患者ICG—R15及治疗方式与预后密切相关，是预后评估的重要指标。
基金The Special Plan for Condition Construction of Gansu Provincial Scientific Research Institutes,No.20JR10RA432.
文摘The present letter to the editor is in response to the research“Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis”by Elshaarawy et al in World J Gastroenterol 2021;13(5):424–439.The preoperative assessment of the liver reserve function in hepatocellular carcinoma(HCC)patients with cirrhosis is crucial,and there is no universal consensus on how to assess it.Based on a retrospective study,Elshaarawy et al investigated the impact of various classical clinical indicators on liver failure and the prognosis after hepatectomy in HCC patients with cirrhosis.We recommend that we should strive to explore new appraisal indicators,such as the indocyanine green retention rate at 15 min.
