肝有效血容量对肝癌术后肝功能不全的预测价值  

Predictive value of effective hepatic blood flow in postopera⁃tive liver insufficiency in patients with hepatocellular carci⁃noma

作　　者：陈森 刘艳国 张永明 杨松竹[1] CHEN Sen;LIU Yan-guo;ZHANG Yong-ming;YANG Song-zhu(Department of Hepatobiliary Surgery,Yantaishan Hosptal,Yantai,Yantai 264000,China)

机构地区：[1]烟台市烟台山医院肝胆外科,山东烟台264000

出　　处：《中国现代普通外科进展》2024年第5期373-376,共4页Chinese Journal of Current Advances in General Surgery

基　　金：吴阶平医学基金会肝病医学部肝功能评估方法研究基金(LDWTPMF-104-2017006)。

摘　　要：目的:探讨肝有效血容量(EHBF)预测肝癌术后肝功能不全发生的价值。方法:回顾123例肝细胞癌手术患者的临床资料,测得EHBF和吲哚菁绿15 min滞留率(ICG R15),并行Child-Pugh评分,观察患者术后肝功能恢复情况。比较不同肝功恢复组中ICG R15、EHBF差异及ICG R15、EHBF不同分组中术后肝功能不全的发生率。通过受试者工作特征(ROC)曲线比较ICG R15、EHBF诊断价值。结果:123例患者中共有41例(33.3%)术后发生肝功能不全。肝功能良好组ICG R15平均值为(8.95±7.18)%,EHBF平均值为(1.01±0.37)L/min;肝功能不全组ICG R15平均值为(15.88±11.55)%,EHBF平均值为(0.75±0.28)L/min。两组差异均有统计学意义(P<0.05)。EHBF≥1.0 L/min组术后肝功能不全发生率13.0%,<1.0 L/min术后肝功能不全发生率45.5%,差异有统计学意义(P<0.05)。ICG R15 ROC曲线下面积0.710(95%CI:0.616~0.804),临界值为7.6,敏感度78.0%,特异度59.8%。EHBF ROC曲线下面积0.718(95%CI:0.624~0.813),临界值为0.35,敏感度73.2%,特异度70.7%。结论:EHBF可有效预测肝癌术后肝功能不全的发生,且可能与ICGR15具有相似检验效能。Objective:To investigate the value of effective hepatic blood flow in predicting the occurrence of liver insufficiency after operation of hepatocellular carcinoma(HCC).Methods:The 15-minute clearance of Indocyanine Green(ICGR15)and EHBFwere measured in 123 patients with hepatocellular carcinoma(HCC)after hepatectomy.To compare the difference of ICGR15 and EHBF in different groups of liver function recovery and the incidence of postoperative liver function insufficiency in different groups of ICG R15 and EHBF.The diagnostic value of ICG R15 and EHBF was compared by receiver operating characteristic(ROC)curve.Results:Of the 123 patients,41(33.3%)developed liver insufficiency after operation.The average values of ICG R15 and EHBF in patients with good liver function were(8.95±7.18)%and(1.01±0.37)min,respectively,while those in patients with liver insufficiency were(15.88±11.55)%and(0.75±0.28)min,respectively.The difference was statistically significant(P<0.05).The incidence of postoperative liver insufficiency was 13.0%in EHBF≥1.0 L/min group and 45.5%in<1.0 L/min group,the difference was statistically significant(P<0.05).The area under the ICG R15 ROC curve was 0.710(95%CI:0.616-0.804),the critical value was 7.6,the sensitivity was 78.0%,and the specificity was 59.8%.The area under the EHBF ROC curve was 0.718(95%CI:0.624-0.813),the critical value was 0.35,the sensitivity was 73.2%,and the specificity was 70.7%.Conclusion:EHBF can effectively predict the occurrence of liver insufficiency after hepatocellular carcinoma operation,and may have the same testing efficacy as ICGR15.

关 键 词：肝肿瘤 肝储备功能 肝功能不全 肝有效血容量 吲哚菁绿 

分 类 号：R735.7[医药卫生—肿瘤]