摘要
目的探讨吲哚菁绿试验对小肝癌患者手术方式选择的指导价值。方法收集143例行吲哚菁绿试验并行肝切除术或经皮肝穿刺射频消融术（PRFA）的小肝癌患者的临床资料，根据不同治疗方式分为肝切组和射频组，再根据术后是否肝功能衰竭（简称肝衰）分为肝切术后肝衰组及非肝衰组和射频术后肝衰组及非肝衰组。比较肝切术后肝衰组和非肝衰组、射频消融术后肝衰组和非肝衰组的临床资料、吲哚菁绿实验15 min滞留率（ICG-R15）、Child-Pugh（CP）分级的差异。根据ICG-R15的不同，将肝切组分为ICG-R15〈20%组、20%〈ICG-R15〈30%组、ICG-R15〉30%组，射频组则分为ICG-R15〈30%组、30%〈ICG-R15〈40%组、ICG-R15〉40%组，比较同一手术方式不同组别之间肝衰率的差异。结果肝切术后肝衰组和非肝衰组、射频术后肝衰组和非肝衰组患者的临床资料差异无统计学意义（P＝0.732、P＝0.686、P＝0.863，P＝0.748、P＝0.862、P＝0.732），ICG-R15、CP分级差异有统计学意义（P＝0.006、P＝0.017、P＝0.046、P＝0.021）。肝切组患者中：ICG-R15〈20%组、20%〈ICG-R15〈30%组、ICG-R15〉30%组肝衰率分别为2.3%、12.5%、55.5%，其中ICG-R15〈20%组与ICG-R15〉30%组肝衰率差异有统计学意义（P＝0.000）。射频组患者中：ICG-R15〈30%组、30%〈ICG-R15〈40%组、ICG-R15〉40%组肝衰率分别为0、11.1%、66.7%，其中ICG-R15〈30%组与ICG-R15〉40%组肝衰率差异有统计学意义（P＝0.001）。结论ICG-R15是评估肝储备功能的敏感指标，对小肝癌手术方式的选择有指导价值。当ICG-R15〈20%时，肝切除术与射频消融术均较为安全。当20%〈ICG-R15〈30%时，建议行射频消融术，但并非肝切除术禁忌证，可结合相应手术风险，全面权衡利弊后决定手术方案。当30%〈ICG-R15〈40%时，不宜行肝切除术，可行射频消融术，但需慎重。当ICG-R15〉40%时，不宜行射频消融�
Objective To investigate the guidance value of indocyanine green test on the selection of small hepatocellular carcinoma operation.Methods The clinical data of 143 cases of small hepatocellular carcinoma who underwent indocyanine green test were collected. These patients have accepted liver resection or percutaneous radiofrequency ablation （PRFA）. They were divided into liver resection group and RF group. On the basis of the occurrence of liver failure after operation, they were divided into liver failure group and non liver failure group again. There was a total of four groups. The clinical data of the four groups were compared, and the diffences in indocyanine green retention rate of 15 min （ICG-R15） and Child-Pugh （CP） grade were observed. Based on the variances of ICG-R15, the patients in liver resection group were streamed into three subgroups： （1） ICG-R15 〈20%; （2） 20%〈ICG-R15 〈30%; （3）ICG-R15 〉30%. Meanwhile, the patients in PRFA group were divided into three subgroups： （1） ICG-R15 〈30%; （2） 30%〈 ICG-R15 〈40%; （3） ICG-R15 〉40%. Finally, the difference in hepatic failure rate was compared between different groups in the same operation mode.Results The differences were not statistically significant in the clinial data among four groups （P=0.732, P=0.686, P=0.863, P=0.748, P=0.862, P=0.732）. However, the difference was statistically significant in ICG-R15 and CP grade （P=0.006, P=0.017, P=0.046, P=0.021）. In the liver resection group, the rate of hepatic failure in ICG-R15 〈20% subgroup, 20%〈 ICG-R15 〈30% subgroup and ICG-R15 〉30% subgroup was 2.3%, 12.5% and 55.5% respectively. The difference was statistically significant between ICG-R15 〈20% subgroup and ICG-R15 〉30% subgroup （P=0.000）. In the PRFA group, the rate of hepatic failure in ICG-R15 〈30% subgroup, 30%〈 ICG-R15 〈40% subgroup and ICG-R15 〉40% subgroup was 0, 11.1% and 66.7%. The difference was statistically significant between ICG-R15 〈30% subgroup and ICG-R15
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2017年第1期123-126,共4页
Chinese Journal of Experimental Surgery
基金
河南省教育厅科技研究重点项目（13A32041）
关键词
小肝癌
肝切除术
射频消融术
吲哚菁绿试验
CHILD-PUGH分级
Small liver resection
Hepatectomy
Radiofrequency catheter ablation
Indocya-nine green test
Child -Pugh classification
