白蛋白-胆红素评分联合术前ICG-R15对肝癌病人肝切除术后肝衰竭的预测价值  

Predictive value of albumin-bilirubin score plus preoperative ICG-R15 for post-hepatectomy liver failure in patients with hepatocellular carcinoma

作　　者：裴俊鹏 丁佑铭[1] 朱明强 熊祥云 杨大帅 沈杰 Pei Junpeng;Ding Youming;Zhu Mingqiang;Xiong Xiangyun;Yang Dashuai;Shen Jie(Department of Hepatobiliary Surgery,Remin Hospital of Wuhan University,Hubei Wuhan 430061,China)

机构地区：[1]武汉大学人民医院肝胆外科,湖北武汉430061

出　　处：《腹部外科》2023年第6期478-483,共6页Journal of Abdominal Surgery

基　　金：国家重点研发计划(2022YFC2407304)。

摘　　要：目的探讨白蛋白-胆红素(albumin-bilirubin score,ALBI)评分联合术前吲哚菁绿15 min滞留率(indocyanine green retention rate at 15 min,ICG-R15)预测肝癌病人肝切除术后肝衰竭(post-hepatectomy liver failure,PHLF)的临床意义。方法回顾性收集2020年1月至2022年8月于武汉大学人民医院行原发性肝癌肝切除术病人的临床资料,依据术后病人肝功能恢复情况分组,发生肝切除术后肝衰竭为PHLF组(38例),未发生肝切除术后肝衰竭为非PHLF组(142例)。利用logistic回归模型分析两组病人临床资料中影响PHLF发生的独立危险因素,根据受试者工作特征(ROC)曲线探讨ALBI评分及ICG-R15对PHLF的预测效能。结果影响PHLF的独立危险因素为:ALBI评分(P=0.001)、术前ICG-R15(P<0.001)、术中出血量(P=0.026)、肝门阻断时间(P=0.042)、切除范围≥3段(P=0.005)和凝血酶原时间(P=0.023)。ALBI评分联合ICG-R15预测PHLF的灵敏度为89.5%,预测效能明显高于ALBI评分、ICG-R15各自单独预测效能,差异具有统计学意义(P<0.001)。结论ALBI评分联合术前ICG-R15对PHLF的预测效能高于各自单独预测效能,更有助于预测PHLF的发生。Objective To explore the preoperative indocyanine green retention rate at 15 min(ICG-R15)plus albumin-bilirubin(ALBI)scoreand determineclinical significanceof ALBI for predicting post-hepatectomy liver failure(PHLF)in patients with primary liver cancer.Methods Clinical data were retrospectively reviewed for patients undergoing hepatectomy for primary liver cancer from January 2020 to August 2022.According to the recovery status of liver function,38 patients with liver failure after hepatectomy were classified as PHLF group and another 142 patients non-PHLF group.And t or Mann-Whitney U test was utilized for comparing the measurement data between two groups,And x?test was used for comparing the count data between two groups.Preoperative ALBI score,preoperative ICG-R15,prothrombin time(PT),intraoperative blood loss and hepatic portal occlusion time were compared to determine whether or not significant inter-group differences existed in potential thrombin time.Results Logistic regression model was utilized for examining the independent risk factors of posthepatectomy liver failure.Receiver operating characteristic(ROC)curve was employed for exploring the predictive efficacy of ALBI score and ICG-R15 for PHLF.ALBI score(P=0.001),preoperative ICG-R15(P<0.001),intraoperative blood loss(P=0.026),hepatic portal occlusion time(P=0.042),resection extent≥3 segments(P=0.005)and PT(P=0.023)wereindependent risk factorsfor postoperativeliver failure.The sensitivity of ALBI score plus ICG-R15 in predicting PHLF was 89.5%and prediction efficiency was significantly higher than that of each alone(P<0.001).Conclusion ALBI score plus ICG-R15 is more effective in predicting the occurrence of postoperative liver failure.

关 键 词：吲哚菁绿15 min滞留率 白蛋白-胆红素评分 原发性肝癌 肝切除术后肝衰竭 危险因素 

分 类 号：R619.5[医药卫生—外科学]