吲哚菁绿试验对小肝癌治疗策略选择的临床应用分析  

Clinical application of indocyanine green test in treatment strategy choice of small hepatocellular carcinoma

作　　者：陈书德[1] 林一鹏 张文智[1] 卢鹏 陈志晔[1] CHEN Shu-de;LIN Yi-peng;ZHANG Wen-zhi;Lu Peng;CHEN Zhi-ye(Departmentment of Hepatobiliary Surgery,Hainan Hospital of PLA General Hospital,Sanya,Hainan 572000,China)

机构地区：[1]解放军总医院海南医院肝胆外科,海南三亚572000

出　　处：《肝胆胰外科杂志》2020年第9期516-519,525,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨吲哚菁绿试验在小肝癌治疗策略选择中的临床应用。方法回顾性分析2017年1月至2019年1月解放军总医院海南医院肝胆外科60例小肝癌患者的临床资料。根据治疗方式不同分为肝切除术组(36例)和射频消融术组(24例),再根据术后是否出现肝衰竭分别把两组分为术后肝衰竭亚组及术后非肝衰竭亚组,比较不同组别的临床资料、吲哚菁绿15 min滞留率(ICG-R15)、Child-Pugh(CP)分值的差异。根据不同的ICG-R15,将肝切除术组及射频消融术组患者再分为ICG-R15<20%亚组、20%≤ICGR15<30%亚组和ICG-R15≥30%亚组,比较相应分组手术后肝衰竭发生率。结果肝切除术组和射频消融术组术前检查及临床资料差异均无统计学意义(P>0.05),ICG-R15、CP分值差异两组有统计学意义(P<0.05)。ICG-R15<20%亚组、20%≤ICG-R15<30%亚组和ICG-R15≥30%亚组的肝切除术患者肝衰竭率分别为6.3%、33.3%、37.5%,射频消融术组对应的肝衰竭率分别为0、12.5%、28.6%。两组的20%≤ICG-R15<30%亚组肝衰竭率具有统计学差异(P<0.05);ICG-R15<20%及ICG-R15≥30%亚组肝衰竭率无统计学差异(P>0.05)。结论ICG-R15是术前评估肝储备功能的可靠指标,对小肝癌手术方式选择具有指导意义。当ICG-R15<20%,手术切除和射频消融治疗小肝癌安全性都高;当20%≤ICG-R15<30%,射频消融术较肝切除术安全性更高;当ICG-R15≥30%,两种手术方式出现肝衰竭风险都较大,应纠正肝功能后再进一步评估手术方式。Objective To investigate the clinical application of indocyanine green(ICG)test in treatment strategy choice of small hepatocellular carcinoma(HCC).Methods Retrospective analysis was performed on the clinical data of 60 patients with small HCC admitted to Department of Hepatobiliary Surgery of Hainan Hospital of PLA from Jan.2017 to Jan.2019.Patients were divided into hepatectomy group(n=36)and radiofrequency ablation group(n=24).The two groups were further divided into liver failure sub group and non-liver failure sub group according to whether liver failure occurred after operation.Clinical data,ICG retention rate of 15 minutes(ICG-R15),and Child-Pugh(CP)score were compared.According to ICG-R15,patients in hepatectomy group and radiofrequency ablation group were further divided into ICG-R15<20%sub group,20%≤ICG-R15<30%sub group and ICG-R15≥30%sub group to compare the incidence of liver failure after the corresponding operation.Results There was no significant difference in preoperative examination and clinical data between patients in hepatectomy group and radiofrequency ablation group(P>0.05).The differences in ICG-R15 and CP score were statistically significant(P<0.05).In hepatectomy group,the rate of liver failure in ICG-R15<20%subgroup,20%≤ICG-R15<30%subgroup and ICG-R15≥30%subgroup was 6.3%,33.3%and 37.5%respectively,while the rate of hepatic failure was 0,12.5%and 28.6%respectively in radiofrequency ablation group.When 20%≤ICG-R15<30%,the difference in the rate of liver failure was statistically significant between hepatectomy group and radiofrequency ablation group(P<0.05);when ICG-R15<20%or ICG-R15≥30%,there was no significant difference in liver failure rate between the two groups(P>0.05).Conclusion ICG-R15 is a reliable index for evaluating liver reserve function before operation and has guiding significance for the treatment choice of small HCC.When ICG-R15<20%,both hepatectomy and radiofrequency ablation are safe for small HCC;when 20%≤ICG-R15<30%,radiofrequency ablation is safer than

关 键 词：小肝癌 吲哚菁绿试验 肝切除术 射频消融术 术后肝衰竭 

分 类 号：R735.7[医药卫生—肿瘤]