吲哚菁绿实验对巴塞罗那B／C期肝癌患者行经导管动脉化疗栓塞术治疗的风险评估  

The value of indocyanine green test in evaluating the risk of super - selective trans - arterial chemo- embolization for stage B/C hepatocellular carcinoma in Barcelona Clinical Liver Classification

作　　者：唐哲[1] 万仁瑞 胡洪涛[1] 任浩[1] 李向阳[1] 张弓[1] 赵永福[1] 

机构地区：[1]郑州大学第一附属医院肝胆胰外科,河南省消化器官移植重点实验室,450052

出　　处：《中华实验外科杂志》2015年第10期2365-2367,共3页Chinese Journal of Experimental Surgery

基　　金：河南省教育厅科技研究重点项目（13A32041）

摘　　要：目的探讨吲哚菁绿（ICG）实验对于评估巴塞罗那（BCLC）-B／C期肝癌患者经导管动脉化疗栓塞（TACE）术后围手术期出现肝功能衰竭的价值。方法分析54例行吲哚菁绿实验并行TACE治疗的BCLC-B／C期患者的临床资料，根据TACE术后是否发生肝衰竭分为肝衰竭组与非肝衰竭组，记录并分析两组患者临床生化指标，吲哚菁绿实验15min滞留率（ICG-R15），Child．Pugh（Ce）分级及终末期肝病模型（MELD）评分的差异。结果两组-般资料差异无统计学意义（P〉0．05）；两组ICG-R15：（27．3±5．0）％、（18．3±5．5）％；Child-Pugh分级：8．75±0．5、6．37±1．0；MELD评分：（23．0±7．5）、（16．6±5．9）分，差异均有统计学意义（P〈0．05）。ICG-R15对于评估TACE术后出现肝功能衰竭的敏感性为87．5％，特异性为13．0％。ICG-R15与CP分级、MELD评分呈显著正相关（r=0．691、0．656，P〈0．01）。结论ICG。R15是评估肝脏储备功能的良好指标，其结合Child-Pugh分级及MELD评分能更好的评估肝脏储备功能。当ICG-R15〈20％，Child-Push分级A级，MELD评分〈20分时，行TACE治疗较为安全；当ICG-R15〉30％，MELD评分〉30分时，禁忌任何有损肝功能的治疗以免发生肝衰竭；介于两者之间的患者，可先行保肝治疗，待肝功能好转或者肝功能分级降低后再行TACE治疗，以减少术后肝衰竭的发生率。Objective To explore the value of indocyanine green test in evaluating liver failure af- ter super- selective trans -arterial chemoembolization （TACE） for stage B/C hepatocellular carcinoma in Barcelona Clinical Liver Classification （BCLC） classification. Methods Analyse the clinical data of 54 patients of BCLC - B/C stage. According to whether Postoperative Liver Failure （PLF） appeared after TA- CE, they were divided into hepatic failure group and non -hepatic failure group. Respectively record and analysis the clinical biochemical parameters, the indocyanine green retention rate at 15 mins （ICG - R15）, Child- Pugh scores, and Model for End -stage Liver Disease （MELD） scores between the two groups. Results Contrast to non - PLF group, the general data of PLF group have no statistical signifi- cance （P 〉 0. 05 ）. The numerical value of ICG - R15 ： （27. 3 ±5.0） %, （ 18.3± 5. 5 ） % ; CP： 27. 3 ± 5. 0, 18. 3±5.5 ; MELD： 23.0±7. 5, 16. 6 ±5.9. And the difference between the two groups are signifi- cantly （ P 〈 0. 05 ）. The sensitivity of ICG - R15 for estimating PLF is 87.5% , and the specificity is 13.0%. ICG - R15 is positively correlated with CTP and MELD score system （P 〈 0. 01 ）. Conclusion ICG - R15 is a sensitive predictor for evaluating liver reserve function. When combined with CP and MELD score system, ICG- R15 would help us make better decision on therapeutic methods for patients with HCC. When the ICG - R15 〈20%, CP grading in A level and MELD 〈20, it＇ s safe to take TACE. When the ICG - R15 〉 30% and MELD 〉 20, we advise not taking any surgery in case of the happening of liver failure. When results are between the above two classification, the recovery of liver function is recommen- ded before TACE.

关 键 词：肝脏肿瘤 经导管动脉化疗栓塞 吲哚菁绿实验 CHILD-PUGH分级 终末期 肝病模型评分 

分 类 号：R735.7[医药卫生—肿瘤]