三种肝脏储备功能评估方法对原发性肝癌切除术后肝损伤的评估作用  

Predictive value of 3 scoring systems on liver injury in patients with primary hepatocellular carcinoma after hepatectomy

作　　者：张晓峰 张达利 牛晓峰 贺希 冯丹妮 刘振文 王洪波 ZHANG Xiao-feng;ZHANG Da-li;NIU Xiao-feng;HE xi;FENG Dan-ni;LIU Zhen-wen;WANG Hong-bo(Senior Department of Hepatology,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心肝病医学部,北京100039

出　　处：《肝脏》2022年第11期1167-1169,1179,共4页Chinese Hepatology

摘　　要：目的探讨3种肝脏储备功能评估方法对原发性肝癌患者肿瘤切除术后肝功能不全的评估作用。方法收集2020年10月至2021年3月解放军总医院第五医学中心原发性肝癌并行肝脏肿瘤切除术患者的临床资料,分析术前肝脏储备功能评估方法对术后肝损伤的评估作用。结果62例患者的肝功能均为Child A级,ICG-R15为4.5(3.5,6.8)%,ALBI 1级26例,ALBI 2级36例。15例(24.19%)患者出现肝切除术后肝功能不全(PHLF)。多因素逐步回归logistic分析结果表明,术前ICG R15>10%(OR=9.111,95%CI:1.910~43.465,P=0.006)是术后肝功能不全的危险因素。ICG R15>10%的患者在术后第1天、第3天、第7天TBil、INR均较ICG R15≤10%的患者高,尤其在术后第7天的TBil(29.7μmol/L比16μmol/L,P=0.042)和INR(1.29比1.20,P=0.032)。结论对于原发性肝癌行肝脏肿瘤切除的Child-Pugh A级的患者来说,ICG R15>10%是术后肝功能不全发生的危险因素。ICG R15分级更能反映术后肝功能损伤指标的动态变化。Objective To investigate the predictive value of 3 scoring systems on liver function in patients with hepatocellular carcinoma(HCC)after hepatectomy.Methods A total of 62 patients with HCC treated by hepatectomy in our hospital from October 2020 to March 2021 were enrolled.The clinical data of all the cases were collected.The predictive value of 3 scoring systems on liver function of patients after operation.Results A total of 62 patients were involved in the study.All the patients were Child-Pugh A,the median ICG R15 was 4.5(3.5,6.8)%.Twenty-six patients were in ALBI grade 1,and 36 patients were in ALBI grade 2.Among 62 patients,15(24.19%)were developed posthepatectomy liver failure(PHLF).Multivariate analysis showed that ICG R15 greater than 10%(OR=9.111,95%CI 1.910-43.465,P=0.006)was a risk factor for PHLF.Compared to the patients with ICG R15 less than 10%,patients with ICG R15 greater than 10%had higher total bilirubin(TBIL)and international normalized ratio(INR)at day 1,day 3 and especially day 7(TBIL:29.7μmol/L vs 16μmol/L,P=0.042,INR:1.29 VS 1.20,P=0.032)after operation.Conclusion ICG R15 greater than 10%is a risk factor for PHLF in HCC patients with Child-Pugh A after hepatectomy.ICG R15 scoreing system can stably reflect the dynamic changes of postoperative liver function.

关 键 词：原发性肝癌 肝功能储备 肝功能不全 吲哚菁绿 

分 类 号：R735.7[医药卫生—肿瘤]