摘要
目的探讨原发性肝细胞癌切除术前应用吲哚菁绿(Indocyanine Green for Injection,ICG)清除试验评价患者肝脏功能、预测术后肝功能不全发生率的价值,并比较术后肝功能恢复与术前肝硬度值的关系。方法选取2015年12月至2017年6月北京佑安医院外科收治的原发性肝癌择期手术患者共64例,术前均行ICG排泄试验,记录ICG-R15、ICG-R10、ICG-R5、有效血流量及ICGK值,检测肝脏硬度值,确定肝功能生化指标进行Child-pugh分级,术后评估肝功能恢复情况。结果64例患者中Child A级53例,Child B级11例,两组间R15、R10、R5、有效血流量、ICGK,术前ALT、术前AST、胆碱酯酶、总胆红素、直接胆红素差异有统计学意义(P<0.05)。ICG-R15<10%、10%~20%、≥20%三组患者,各组例数分别为38例、11例和15例,术后发生肝功能不全的例数分别为7例、4例、8例,差异有统计学意义(P<0.05)。Child A组R15与术前ALT、术前AST、胆碱酯酶、总胆红素及直接胆红素相关系数分别为0.361、0.486、-0.526、0.41和0.327。对比术后肝功能不全组与未出现肝功能不全组术前肝弹性值,两组间差异有统计学意义(P<0.05)。结论吲哚菁绿清除试验及肝脏硬度值可用于评价原发性肝癌患者术前肝脏功能情况,帮助预测术后肝功能不全发生的风险。
Objective To evaluate the hepatic reserve function of patients with primary hepatocellular carcinoma(HCC)by indocyanine green(ICG)retention test before resection,to predict postoperative hepatic dysfunction,and to analyze the relationship between postoperative liver function recovery and preoperative liver stiffness measurement(LSM)value.Methods A total of 64 patients with HCC who underwent selective surgeries in our hospital from December 2015 to June 2017 were enrolled.All subjects accepted preoperative ICG retention test,ICG 15-minute retention(ICG-R15),ICG-R10,ICG-R5,effective blood flow and ICG elimination rate(ICGK)were recorded.All subjects were examined by Fibroscan-502 to obtain the LSM values.Biochemical indexes of liver function were detected to confirm the Child-Pugh classification.The recovery of liver functions was analyzed after the operation.Results①Among the 64 patients,there were 53 cases of Child-Pugh A and 11 cases of Child-Pugh B.According to the classification of liver function,statistical analysis showed that there were significant differences between the 2 groups in ICG-R15,ICG-R10,ICG-R5,effective blood flow,ICGK,preoperative alanine aminotransferase(ALT),preoperative aspartate aminotransferase(AST),cholinesterase,total bilirubin and direct bilirubin(P<0.05).②According to the ICG-R15 values,they were divided into 3 groups:less than 10%,between 10%and 20%,more than or equal to 20%.The number of cases in each group was 38,11 and 15,respectively.There were 7,4 and 8 cases who had postoperative liver dysfunction in the 3 groups,the incidence was 18.4%,36.4%and 53.3%,respectively.There was significant difference among the 3 groups(P<0.05).③In the Child-Pugh A group,R15 was associated with preoperative ALT,preoperative AST,cholinesterase,total bilirubin,and direct bilirubin.The correlation coefficients were 0.361,0.486,-0.526,0.41,and 0.327,respectively.④The difference of preoperative LSM value between the liver dysfunction and the non-hepatic dysfunction groups was statistically signif
作者
徐晓鸾
孟繁坤
郑颖
孙丽娟
李欣
XU Xiao-luan;MENG Fan-kun;ZHENG Ying;SUN Li-juan;LI Xin(Ultrasonic and Functional Diagnosis Center,YouAn Hospital,Capital Medical University,Beijing 100069,China)
出处
《肝脏》
2020年第3期264-266,281,共4页
Chinese Hepatology
关键词
吲哚菁绿清除试验
肝脏储备功能
肝脏硬度值
原发性肝细胞癌
肝功能不全
Indocyanine green retention test
Liver reserve function
Liver stiffness measurement
Primary hepatocellular carcinoma
Liver dysfunction
