CAJ | 학술논문

目的结合吲哚氰绿(ICG)排泄试验及标准余肝体积探讨预防肝切除术后肝功能中、重度代偿不全的安全切肝界限.方法对2007年3月至2008年2月期间收治的75例因肝癌行肝切除术的患者进行研究分析,根据术后肝功能代偿状况分组,将术后发生肝功能中度代偿不全患者术前ICG 15 min潴留率(ICGR15)值与术后标准余肝体积进行直线回归分析.结果全部患者中,术后发生肝功能轻度代偿不全60例,中度代偿不全12例,重度代偿不全3例.轻度代偿不全组与中重度代偿不全组患者的年龄[(50±13)岁和(53±9)岁]、术前Child-Pugh评分[(5.4±0.6)分和(5.7±0.9)分]、凝血酶原时间[(13.6±1.0)s和(13.5±1.0)s]、国际标准化比值(1.09±0.10和1.06±0.10)等指标的差异均无统计学意义(P>0.05);而两组ICG排泄试验中的K值(0.20±0.04和0.17±0.03)和ICGR15值(6±4和9±4)以及术后标准余肝体积[(545±93)ml和(398±82)ml]的差异均有统计学意义(P<0.05).将术后肝功能中度代偿不全患者术前ICGR15值和术后标准余肝体积进行直线回归分析,发现两者呈正相关(R=0.640,P=0.025),回归方程为:标准余肝体积(ml/m~2)=1594.6×ICGR15+265.结论将ICG排泄试验和标准余肝体积结合起来评估患者肝脏储备功能,有助于预测患者术后发生肝功能损害的程度及预防患者术后发生肝功能中、重度代偿不全.
목적 결합신타청록(ICG)배설시험급표준여간체적탐토예방간절제술후간공능중、중도대상불전적안전절간계한.방법 대2007년3월지2008년2월기간수치적75례인간암행간절제술적환자진행연구분석,근거술후간공능대상상황분조,장술후발생간공능중도대상불전환자술전ICG 15 min저류솔(ICGR15)치여술후표준여간체적진행직선회귀분석.결과 전부환자중,술후발생간공능경도대상불전60례,중도대상불전12례,중도대상불전3례.경도대상불전조여중중도대상불전조환자적년령[(50±13)세화(53±9)세]、술전Child-Pugh평분[(5.4±0.6)분화(5.7±0.9)분]、응혈매원시간[(13.6±1.0)s화(13.5±1.0)s]、국제표준화비치(1.09±0.10화1.06±0.10)등지표적차이균무통계학의의(P>0.05);이량조ICG배설시험중적K치(0.20±0.04화0.17±0.03)화ICGR15치(6±4화9±4)이급술후표준여간체적[(545±93)ml화(398±82)ml]적차이균유통계학의의(P<0.05).장술후간공능중도대상불전환자술전ICGR15치화술후표준여간체적진행직선회귀분석,발현량자정정상관(R=0.640,P=0.025),회귀방정위:표준여간체적(ml/m~2)=1594.6×ICGR15+265.결론 장ICG배설시험화표준여간체적결합기래평고환자간장저비공능,유조우예측환자술후발생간공능손해적정도급예방환자술후발생간공능중、중도대상불전.
Objective To discuss the safety line to avoid the post-hepatectomy hepatic insufficiency by combining indocyanine green test by pulse dye-densitometry (PDD-ICG) and standard remnant liver volume (SRLV). Methods Seventy-five hepatic cancer patients undergone hepatectomy from March 2007 to February 2008 were included. According to the liver function decompensatory grades after operation, the relationship between ICG retention rate at 15 min(ICGR15) and standard remnant liver volume by linear regression were analyzed. Results There were 60 cases with slight hepatic insufficiency, 12 cases with moderate hepatic insufficiency,and 3 cases with severe hepatic insufficiency. There were no difference in age [(50±13) years old and (53±9) years old], prothrombin time [(13.6±1.0)s and (13.5±1.0) s],international normalized ratio(1.09±0.10 and 1.06±0.10) between slight hepatic insufficiency group and moderate and severe hepatic insufficiency group(P>0.05). And there were difference in K value(0.20±0.04 and 0.17±0.03),ICGR15(6±4 and 9±4),SRLV[(545±93) ml and (398±82) ml]between two groups (P < 0.05). Compared ICG test and standard remnant liver volume of the patients with moderate hepatic insufficiency after operation, the liner relationship was found (R=0.640, P=0.025), and the regression equation was:standard remnant liver volume(ml/m~2)=1594.6×ICGRI5+265. Conclusions PDD-ICG test and standard remnant liver volume are effective to estimate hepatic function reserve of patient undergone hepatectomy.