摘要
目的 探讨功能性残肝体积比联合吲哚氰绿15 min内滞留率（indocyanine green retention rate at 15 minute,ICG R15）评估选择性出入肝血流阻断肝切除术肝储备功能.方法 回顾分析2012年8月至2015年7月对83例合并乙型肝炎后肝硬化行区域性出入肝血流阻断肝切除术的肝细胞癌病人资料.检测术前Child-Pugh分级评分、ICG R15和术后肝功能不全程度,行术前CT和术中排水法计算功能性残肝体积比（ratio of functional remnant liver volume,％RLV）.Child-Pugh评分分为A级、B级二组,ICG R15分为＜10％、10％～20％、＞20％三组,％RLV分为40％～60％、60％～80％、＞80％三组,术后肝功能不全程度分为轻度、中度、重度三组.在Child-Pugh评分基础上,％RLV联合ICG R15对比分析肝储备功能,x^2检验和t检验分析差异性.结果 不同肝功能不全组ICG R15组内差异有统计学意义（P＜0.05）,％RLV组内差异有统计学意义（P＜0.01）.随着ICGR15递增和％RLV下降术后肝功能不全程度渐加重,差异有统计学意义（P＜0.05）.重度肝功能不全均发生于Child-Pugh B级.平均阻断时间为（17±12） min,阻断1次62例,间歇5 min阻断2次11例,阻断3次10例.术中平均出血量为（437±316） ml,围手术期无死亡病例.结论 功能性残肝体积比联合ICG R15较Child-Pugh分级更精确预测选择性出入肝血流阻断肝切除术肝功能不全程度.
Objective To evaluate hepatic reserve function by ratio of functional remnant liver volume （%RLV） combined with ICG R15 for indication of hepatectomy by selective hepatic vascular occlusion （SHVO）. Methods A retrospective analysis of hepatic reserve function was performed by RLV combined with ICG R15 for hepatectomy by SHVO. Eighty-three patients with hepatocellular carcinoma and posthapatitic B cirrhosis were hospitalized from Aug. 2012 to July 2015. The data of pre-hepatectomy Child-Pugh score, ICG R15 and the extent of post-hepatectomy liver dysfunction were tested. % RLV was computed by CT before operation and drainage method during operation. The patients were divided into 2 groups of Child-Pugh A and B. The patients were divided into 3 groups of ICG R15〈10%, ICG R15 10%-20% and ICG R15%20%. The patients were divided into 3 groups of %RLV 40%-60%, 60%-80% and 〉80%. The patients were divided into mild, moderate and severe groups according to post-hepateetomy liver dysfunction. The hepatic reserve function was evaluated by %RLV combined with ICG R15 on the basis of Child-Pugh score. The data were analyzed by T test or Chi-square test. Results The differences among the groups of ICG R15 were significant in different groups of posvhepateetomy liver dysfunction （P〈0. 05）. The differences among the groups of %RLV were very significant （P〈0. 01）. As ICG R15 increased and %RLV decreased, the extent of post-hepateetomy liver dysfunction aggravated gradually （P〈0. 05）. Severe post-hepateetomy liver dysfunction occurred in group of Child-Pugh B. The average blocking time was （17 ± 12） rain. Sixty-two patients were subjected to continuous occlusion. Eleven and 10 patients respectively underwent 2 and 3 times of intermittent occlusion with an interval of 5 min. Average amount of blood loss was （437 ±316） mL. There were no perioperative deaths. Conclusions %RLV combined with ICG R15 may more accurately predict the extent of post-hepatectomy liver dysfunction by SHVO than Child-Pugh classification.
出处
《腹部外科》
2016年第3期214-217,共4页
Journal of Abdominal Surgery
关键词
肝细胞癌
肝切除术
肝体积比
吲哚氰绿清除试验
Hepatoeellular carcinoma
Hepatectomy
Liver volume ratio
Indocyanine green retention test
