肝部分切除术后连续监测吲哚菁绿15分钟滞留率联合标准残肝体积对肝细胞癌患者肝功能不全的预测价值  

Predictive value of continuous monitoring of indocyanine green retention rate at 15 minutes combined with standard residual liver volume for hepatic insufficiency in patients with hepatocellular carcinoma after partial hepatectomy

作　　者：罗宇君 张雅敏[2] LUO Yujun;ZHANG Yamin(Wuhan Children’s Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China;Department of Hepatobiliary Surgery,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院),武汉430000 [2]天津市第一中心医院肝胆外科,天津300192

出　　处：《临床肝胆病杂志》2024年第6期1162-1168,共7页Journal of Clinical Hepatology

基　　金：天津市卫生局科技基金重点项目(2013KR05);天津市卫生局重点支撑项目(2014KR08)。

摘　　要：目的探讨肝部分切除术后连续性监测吲哚菁绿15分钟滞留率(ICG-R15)联合标准残肝体积(SRLV)对术后肝功能不全发生率的预测价值。方法收集天津市第一中心医院肝胆外科2016年11月—2017年5月收治的70例肝细胞癌患者的临床资料。根据患者术后是否发生肝功能不全的情况,分为肝功能良好组(n=56)与肝功能不全组(n=14)。根据术前肝功能评估及强化CT计算切除肝体积和剩余肝体积以及肝脏三维重建,术中B超定位决定手术方案,根据术中情况决定采用选择性肝门入肝血流阻断或间断全肝门阻断,CUSA联合双极滴水电凝镊离断肝实质。计算SRLV并连续监测患者ICGR15。计量资料两组间比较采用成组t检验;计数资料组间比较采用χ2检验;采用受试者工作特征曲线(ROC曲线)下面积(AUC)评估预测术后肝功能不全的准确性。多因素Logistic回归分析建立术后肝功能不全的预测模型,制订SLRV联合术后ICG-R15动态监测对术后肝功能不全的诊断标准。结果两组术前以及术后即时、3 d、5 d的ICG-R15,以及SRLV、Child分级比较,差异均有统计学意义(P值均<0.05)。术前、术后即时、术后3 d、术后5 d患者术后肝功能不全发生率均随ICGR15升高而升高(P值均<0.001)。进一步两两比较,术前、术后即时、术后3 d、术后5 d ICG-R15>20%组与其他两组患者肝功能不全发生率比较,差异均有统计学意义(P值均<0.001);术后即时,ICG-R15<10%组与10%≤ICG-R15≤20%组肝功能不全发生率比较,差异有统计学意义(P<0.001)。术前ICG-R15、术后即时ICG-R15、术后3 d ICG-R15、术后5 d ICG-R15预测术后肝功能不全的AUC分别为0.790、0.857、0.855、0.870,术后即时、3 d、5 d ICG-R15的AUC均大于术前,差异均有统计学意义(P值均<0.05)。多因素分析结果显示,SRLV以及ICG-R15术后动态监测(术后即时、术后3 d、术后5 d)水平升高均为术后肝功能不全的独立危险因素,术前BMI升�Objective To investigate the value of continuous monitoring of indocyanine green retention rate at 15 minutes(ICG-R15)combined with standard residual liver volume(SRLV)in predicting hepatic insufficiency after partial hepatectomy.Methods Clinical data and SRLV data were collected from 70 patients with hepatocellular carcinoma who were admitted to Department of Hepatobiliary Surgery,Tianjin First Central Hospital,from November 2016 to May 2017.According to the presence or absence of hepatic insufficiency after surgery,the patients were divided into good liver function group with 56 patients and hepatic insufficiency group with 14 patients.Based on preoperative liver function evaluation and contrast-enhanced CT scans,resected liver volume and residual liver volume were calculated,and three-dimensional reconstruction of the liver was performed.Intraoperative ultrasound localization was performed to determine the surgical regimen,and selective hepatic inflow occlusion or intermittent hepatic portal occlusion was selected based on intraoperative conditions.CUSA combined with BIPOLAR drip electric coagulation forceps were used for the partition of liver parenchyma.SRLV was calculated,and ICG-R15 was monitored continuously.The independent-samples t test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups;the area under the ROC curve(AUC)was used to investigate the accuracy in predicting hepatic insufficiency after surgery.A multivariate Logistic regression analysis was used to establish a predictive model for postoperative hepatic insufficiency,and diagnostic criteria were developed for SLRV combined with postoperative ICG-R15 dynamic monitoring in the diagnosis of postoperative hepatic insufficiency.Results There were significant differences between the two groups in ICG-R15 before surgery,immediately after surgery,and on days 3 and 5 after surgery,as well as significant differences in SRLV and Child class(all P<0.05).The i

关 键 词：肝肿瘤 肝切除术 吲哚菁绿 肝功能不全 

分 类 号：R735.7[医药卫生—肿瘤]