术中残肝吲哚菁绿试验对肝切除术后肝功能衰竭的预测价值及预后相关性的研究  

Prognostic value of intraoperative residual liver indocyanine green test in predicting posthepatectomy liver failure and its correlation with prognosis in patients with hepatocellular carcinoma and hepatitis B related cirrhosis

作　　者：王兵济 司安锋 嵇惠宇 郝保兵 方相春 江涛 王轩 WANG Bingji;SI Anfeng;JI Huiyu;HAO Baobing;FANG Xiangchun;JIANG Tao;WANG Xuan(Cancer Center of PLA, Qin Huai Medical District of Eastem Theater General Hospital, Nanjing 210002, China)

机构地区：[1]东部战区总医院秦淮医疗区肿瘤科,南京210002

出　　处：《临床肿瘤学杂志》2021年第12期1119-1126,共8页Chinese Clinical Oncology

摘　　要：目的探讨残肝吲哚菁绿15分钟滞留率(ICG-R15)对肝癌患者术后肝功能衰竭(PHLF)的预测价值。方法分析2014年4月至2019年4月间接受手术的92例乙肝肝硬化肝癌患者的临床病理资料。采用受试者工作特征曲线计算残肝ICG-R15的最佳临界值。Kaplan-Meier法绘制生存曲线并行Log-rank检验,Logistic模型分析与PHLF相关的因素,Cox模型分析与预后相关的因素。结果92例患者中,21(22.8%)例发生PHLF,残肝ICG-R15最佳临界值是15.8%。21和71例患者残肝ICG-R15>和≤15.8%,分别有13(61.9%)和8(11.3%)例发生PHLF(P<0.001)。Logistic分析示:手术时间>3 h和残肝ICG-R15>15.8%是发生PHLF的危险因素。发生PHLF的患者术后远期预后差于未发生PHLF的患者。残肝ICG-R15>和≤15.8%的患者具有相似的预后。多因素分析显示PHLF是影响患者远期预后的危险因素。结论残肝ICG-R15可以预测乙肝肝硬化肝癌患者PHLF,但不能预测远期预后。PHLF会导致远期预后的恶化,围手术期要特别重视PHLF的发生和预防。Objective To explore the predictive value of intraoperative residual liver indocyanine green test at 15 min(ICG-R15)in predicting posthepatectomy liver failure(PHLF)in patients with hepatocellular carcinoma(HCC)and hepatitis B related cirrhosis.Methods An analysis was performed on 92 patients with HCC and hepatitis B related cirrhosis who underwent radical resection between April 2014 and April 2019.The cut-off value for the residual liver ICG-R15 was selected using receiver operating characteristic curve analysis.Survival curves were calculated using the Kaplan-Meier method and compared using the Log-rank test.Logistic regression model was used to analyze the factors related to PHLF.Multivariate Cox proportional hazard model was performed to identify independent risk factors associated with long-term survival.Results Of the 92 patients,21(22.8%)had PHLF.The optimal cut-off value for residual liver ICG-R15 was 15.8%.Of the 21 patients with residual liver ICG-R15>15.8%,13(61.9%)patients had PHLF and of the 71 patients with residual liver ICG-R15≤15.8%,8(11.3%)patients had PHLF,and there was statistical difference(P<0.001).Logistic regression analysis showed that operation time>3 h and residual liver ICG-R15>15.8%were independent risk factors for PHLF.The long-term prognosis of patients with PHLF was significantly lower than those without PHLF.The long-term prognosis of patients with residual liver ICG-R15>15.8%was similar to those of patients with residual liver ICG-R15≤15.8%.Multivariate Cox regression analysis showed that PHLF was an independent risk factor for long-term prognosis.Conclusion The residual liver ICG-R15 can predict PHLF in patients with HCC and hepatitis B related cirrhosis,but can not predict the long-term prognosis.The occurrence of PHLF can affect the long-term prognosis,and we should pay special attention to the occurrence and prevention of PHLF during perioperative period.

关 键 词：肝细胞癌 乙肝肝硬化 肝切除术 残肝ICG-R15 肝功能衰竭 预测价值 

分 类 号：R735.7[医药卫生—肿瘤]