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

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,Lo...     

不同肝体积评估指标预测肝癌术后肝功能衰竭的效能分析

目的 评估残肝分数（remnant liver volume to total liver volume,%RLV）、残肝体积/标准肝体积（remnant liver volume to standard liver volume,RLV/SLV）、残肝体积/体重比率（remnant liver volume to body weight ratio,RLV/BW）、标准残肝体积（standard remnant liver volume,SRLV）预测肝细胞癌（hepatocellular carcinoma,HCC）患者行半肝切除术后发生肝功能衰竭（post-hepatectomy liver failure,PHLF）的效能。方法 收集2013年9月至2016年8月于广西医科大学附属肿瘤医院行肝切除术的1 446例乙型肝炎病毒相关性HCC患者（HBV-HCC）,根据是否发生PHLF分为PHLF组和无PHLF组。采用ROC曲线分析%RLV、RLV/SLV、RLV/BW、SRLV预测术后肝功能衰竭的效能,并比较术后并发症发生率。 结果 本研究共纳入181例HBV-HCC患者,其中PHLF组22例,无PHLF组159例,两组患者%RLV、RLV/SLV、RLV/BW、SRLV比较差异有统计学意义（P＜0.05）。ROC曲线分析显示,%RLV、RLV/SLV、RLV/BW、SRLV的AUC分别为0.77、0.91、0.84、0.91,SRLV 预测术后PHLF 的效能优于%RLV及RLV/BW,差异有统计学意义（P＜0.05）。以SRLV截点值340 mL/m²分组,SRLV>340 mL/m²组及SRLV≤340 mL/m²组患者术后重度并发症发生率差异有统计学意义（P＜0.01）。结论 SRLV及RLV/SLV较RLV/BW及%RLV在预测HCC患者接受半肝切除术后发生肝功能衰竭中具有更高的效能,当SRLV≤340 mL/m²时患者术后肝功能衰竭及重度并发症发生率更高。     

吲哚氰绿清除试验测定肝储备功能对肝癌治疗方案的指导价值

目的 探讨吲哚氰绿清除试验测定肝储备功能对肝癌治疗方案的临床指导价值.方法 选择收治的拟实施手术治疗的80例肝癌,按照随机数字法分为两组,各40例,对照组根据以上检查结果拟定治疗方案,观察组则于术前使用脉动色素浓度测定法行吲哚氰绿清除试验,对所有入组者通过门诊或住院随访2年,比较干预前后3个月两组AFP变化情况,两组手术治疗情况,两组生存时间以及干预前后3个月两组生活质量情况.结果 观察组解剖性切除比例显著高于对照组(P<0.05),干预后观察组AFP水平低于干预前及干预后对照组(P<0.05),观察组1年及2年生存率均显著高于对照组,干预后两组生活质量评分优于干预前(P<0.05),且干预后观察组生活质量评分优于干预后对照组(P<0.05).结论 肝癌术前行吲哚氰绿清除试验评估肝脏储备功能,进而指导手术治疗方案,能更有效的提高解剖性肝脏病灶切除比例,延长患者生存时间,提高其生活质量.     

标准残肝体积预测肝癌合并肝硬化患者半肝切除术后肝功能衰竭的临床研究

  目的  探讨肝细胞癌（hepatocellular carcinoma,HCC）合并肝硬化患者肝切术标准残肝体积（the standard remnant liver vol-ume,SRLV）的安全临界值及其评估术后肝功能衰竭（post-hepatectomy liver failure,PHLF）的效能。  方法  回顾性分析广西医科大学附属肿瘤医院2013年9月~2016年8月共181例半肝切除术HCC患者临床资料,术前测定肝脏总体积、肿瘤体积、残肝体积、切除的肝体积。术中排水法测定切除标本的体积。按照“50-50标准”分成肝衰竭组（22例）与无肝衰竭组（159例）,分析发生PHLF的相关因素,统计分析肝硬化亚组SRLV的临界值及其预测PHLF效能,并回顾性分析肝硬化患者的CT分级资料。  结果  术后共发生PHLF 22例,PHLF相关死亡1例。多因素分析显示术前胆红素水平及SRLV是发生PHLF的危险因素。按照肝硬化病理进行亚组分析,肝硬化组102例（Ⅰ、Ⅱ级肝硬化84例,Ⅲ级肝硬化18例,无Ⅳ级肝硬化）,18例发生PHLF,PHLF相关死亡1例。HCC合并肝硬化行半肝切除发生PHLF的SRLV临界值为340 mL/m2（灵敏度94.4%,特异度74.7%,曲线下面积0.861,P＜0.01）。  结论  SRLV≤340 mL/m2的HCC合并肝硬化患者在行半肝切除术后,发生PHLF的风险增高。      

标准残肝体积联合肝纤维化测定在原发性肝癌切除术安全性评估中的价值

[目的]探讨标准残肝体积(SRLV)大小及肝纤维化程度与原发性肝癌切除术后发生肝功能代偿不全间的关系.[方法]对因肝癌行肝切除术的104例病例进行研究.残肝体积=全肝体积-切除肝脏体积;SRLV=残肝体积/体表面积;根据声脉冲辐射力成像(acoustic radiation force impulse,ARFI)评分将所有病例分为A组(中、重度肝纤维化组)和B组(正常或轻度肝纤维化组).通过受试者工作特征曲线(ROC)分析预防发生肝功能代偿不全的SRLV安全临界值.并将术后发生肝功能中度代偿不全患者的术前ARFI评分与术后SRLV进行直线回归分析.[结果]A组病例术后发生肝功能轻度代偿不全、中度代偿不全及重度代偿不全分别为53例、22例、4例.在A组病例中,肝功能中、重度代偿不全发生率为32.9％,(26/79),肝功能轻度代偿不全患者和中、重度代偿不全患者的SRLV[(605.69±1 18.98)ml/m2 vs (470.81±62.59)ml/m2]比较具有显著差异(P＜0.05).ROC曲线分析提示发生肝功能中、重度代偿不全的SRLV的临界值为503ml/m2.B组病例数少,不作统计学分析.将术后发生肝功能中度代偿不全患者的术前ARFI评分及术后SRLV进行直线回归分析,显示呈正相关(R=0.719,P＜0.01),其回归方程为:SRLV(ml/m2)=149.6×A RFI评分(m/s)+194.1.[结论]联合SRLV及肝纤维化程度测定对原发性肝癌术前安全切肝量评估有重要指导价值,对伴中、重度肝纤维化患者安全SRLV临界值为503ml/m2.     

肝细胞癌患者术前ＨＢＶ ＤＮＡ含量对术后肝功能影响的初步研究

目的　探讨肝细胞癌（ＨＣＣ）患者术前ＨＢＶＤＮＡ含量对切除术后肝功能恢复的影响。方法　收集我科２００７年１月至２００７年６月行手术切除治疗的原发性肝癌患者共２１７例,应用实时荧光定量ＰＣＲ方法检测血清中ＨＢＶＤＮＡ,按照ＨＢＶＤＮＡ含量分为两组：Ａ组（ＨＢＶＤＮＡ≥１.０×１０^５拷贝／ｍｌ）６８例,Ｂ组（ＨＢＶＤＮＡ＜１.０×１０^５拷贝／ｍｌ）１４９例。严密观察患者术后肝功能变化情况,采用ＳＰＳＳ１３.０软件进行统计分析。结果　术后两组患者的肝功能变化存在着显著差异,Ａ组的肝功能损伤程度高于Ｂ组。术后第１、３、７天,丙氨酸氨基转移酶（ＡＬＴ）和天门冬氨酸氨基转移酶（ＡＳＴ）数值Ａ组明显高于Ｂ组,而前白蛋白数值则Ｂ组高于Ａ组,两组差异有统计学意义（Ｐ＜００５）;术后第３、７天,总胆红素（ＴＢＩＬ）数值Ａ组明显高于Ｂ组,两组差异有统计学意义（Ｐ＜０.０５）。除术前凝血酶原时间（ＰＴ）、前白蛋白、ＴＢＩＬ、ＡＳＴ和术中肝门阻断时间外,术前ＨＢＶＤＮＡ浓度对术后第７天的血清ＴＢＩＬ水平有显著影响。结论　ＨＣＣ患者术前ＨＢＶＤＮＡ含量对于术后肝功能恢复有明显影响,对术前ＨＢＶＤＮＡ含量较高的患者应在治疗肝癌的同时给予抗病毒治疗。     

吲哚靛青绿储留率判断切肝量及其与肝癌术后肝功能不全的关系

背景与目的:肝癌术前正确评估肝脏储备功能、术中合理掌握切肝量是避免肝功能衰竭的重要措施。近年来,吲哚靛青绿储留率(indocyaninegreenretentionrateat15min,ICGR15)已被认为是反映肝脏储备功能的灵敏指标。如何根据肝脏储备功能特别是ICGR15来决定所能切除的最大肝脏体积,目前未有定论。本研究旨在探讨术前ICGR15与术中切除肝体积对术后肝功能不全的影响。方法:对225例手术切除的肝细胞肝癌患者进行研究。观察指标包括术前ICGR15的测定,术中切除的肝段数以及术后患者出现肝功能不全的情况。结果:ICGR15<10%时,切除A组(切除肝段数相当于一个肝段以内)、B组(切除肝段数大于一个肝段,但在两个肝段以内)、C组(切除肝段数大于两个肝段)肝段的腹水产生率分别为21.2%、14.3%、15.4%(P>0.05);黄疸率分别为3.0%、7.1%、15.4%(P>0.05)。ICGR15介于10%～20%时,腹水产生率分别为26.8%、38.9%、50.0%(P>0.05);黄疸率分别为0、27.8%、20.0%,(P<0.01);其中2例死亡,均切除两个或以上肝段。ICGR15>20%时,6例切除A组肝段的患者中有2人出现腹水;而仅有2例切除B组肝段的患者均出现腹水和黄疸,其中1例死亡。结论:可根据ICGR15值粗略决定肝脏切除量。ICGR15<10%时,可切除两个或更多的肝段;ICGR15介于10%～20%时,切除一个肝     

残肝体积/体重比率预测肝癌合并肝硬化患者术后肝功能衰竭的研究

目的 探讨肝细胞性肝癌（HCC）合并肝硬化患者残肝体积/体重比率（RLV-BWR）的安全临界值及其评估术后肝功能衰竭（PHLF）的效能。方法 分析181例行半肝切除的HCC患者临床资料,术前采用Myrian-Liver手术规划系统测定肝脏总体积、肿瘤体积、残肝体积,切除的肝体积。术中排水法测定切除标本体积。按照“50-50标准”分成肝衰竭组与无肝衰竭组,分析发生PHLF的相关因素,统计分析肝硬化亚组RLV-BWR的临界值及其预测PHLF的效能,回顾性分析患者肝硬化背景CT分级。结果 术后共发生PHLF22例,PHLF相关死亡1例。多因素分析显示术前胆红素水平及RLV-BWR是发生PHLF的危险因素。按照术后肝硬化病理进行亚组分析,肝硬化组102例,18例术后发生PHLF,PHLF相关死亡1例。HCC合并肝硬化行半肝切除发生PHLF的RLV-BWR临界值为0.94%（ROC=0.853, P<0.01,敏感度94.4%,特异性72.3%）。半肝切除肝硬化患者CT评级为Ⅰ~Ⅲ级。结论 对RLV-BWR≤0.94%的HCC合并肝硬化患者行半肝切除术,术后发生PHLF风险增高。     

肝癌切除术中氩气刀处理残肝断面对术后肿瘤局部复发的影响

目的 肝癌术后复发和转移是制约肝癌手术疗效的重要因素,如何有效地预防和治疗肝癌术后复发转移是目前研究的重点和难点.本研究旨在探讨肝癌手术中应用氩气刀处理残肝断面对患者术后肿瘤局部复发和生存率的影响.方法 回顾性分析329例第二军医大学附属东方肝胆外科医院2010-01-01-2013-01-31不能根治性切除肝癌手术患者,分氩气刀组和传统电刀组,对两组患者术后肿瘤局部复发时间和总生存率进行比较.结果 氩气刀组术后3个月、6个月、9个月、1年和2年复发率分别为24.3％、37.8％、69.3％、82.1％和90.8％,传统电刀组分别为30.8％、58.3％、78.4％、89.1％和96.7％,两组中位复发时间分别为(6±1.7)和(4±1.3)个月.传统电刀组局部复发率明显高于氩气刀组,复发时间明显缩短,差异有统计学意义,x2=11.705,P=0.001.氩气刀组患者术后6个月、1年、2年和3年总生存率分别为91.6％、60.4％、23.3％和10.1％,传统电刀组分别为80.1％、45.8％、12.5％和7.1％,两组中位生存期分别为(16±5.2)和(10±6.5)个月,氩气刀组总生存率明显高于传统电刀组,中住生存期明显延长,差异有统计学意义,x2 =8.746,P=0.003.结论 肝癌术中应用氩气刀处理残肝断面可杀灭创面残留肿瘤细胞,减少肿瘤复发,在降低术后肿瘤局部复发率、提高患者总生存率以及延长生存时间等方面有积极的临床意义,值得临床推广.     

Predictive value of indocyanine green retention rate with respect to complications of radiofrequency ablation in 878 patients with hepatocellular carcinoma

Background and aims: Radiofrequency ablation (RFA) is a minimally invasive technique used for the treatment of hepatocellular carcinoma (HCC). It may produce complications. The indocyanine green (ICG) retention rate at 15?min (ICGR15) has been used to predict complications after hepatectomy. In this study, the prediction of the value of ICGR15 for complications of RFA to the patients with HCC was evaluated.

Methods: Some 878 cases of HCC treated between June 2009 and June 2013 were evaluated. All patients were treated by percutaneous radiofrequency ablation. Patients were divided into two groups: a complication group (85 cases) and a complication-free group (793 cases). ICGR15 and other baseline characteristics of the two groups were compared. A logistic regression model was used to analyse the merits of assessing liver reserve to predict complications post-RFA.

Results: Complications such as intra-abdominal haemorrhage and pleural effusion occurred in 85 (9.68%) patients after RFA. Patients in the two groups did not differ with regard to baseline parameters. Patients in the two groups did differ significantly in ICGR15 and tumour site (p?Conclusions: The present results demonstrated that RFA is minimally invasive and suitable for the treatment of HCC. They also showed that ICGR15 did not independently predict for liklihood of post-RFA complications, after controlling for tumour site. Patients with tumours located subcapsularly or near the porta hepatis were found to have significantly higher rates of post-operative complications after RFA than to patients with tumours in the liver parenchyma.     

Association between pretreatment retention rate of indocyanine green 15 min after administration and life prognosis in patients with HCC treated by proton beam therapy

PurposeThe Child-Pugh score is often used to judge the outcome of radiotherapy for hepatocellular carcinoma (HCC). The retention rate of indocyanine green 15 min after administration (ICG R15) can also be used to predict prognosis after liver resection. We evaluated the utility of ICG R15 for prediction of outcomes after proton beam therapy (PBT) for HCC.Methods and materialsA retrospective evaluation was performed in 250 patients who received PBT between 2002 and 2007. The patients (178 males and 72 females) had a median age of 71 years (range: 43–88). Child-Pugh categories were A (score 5–6), B (7–9), and C (10–15) in 197, 51, and 2 patients, respectively. ICG scores were 0–<10, 10–<20, 20–<30, 30–<40 and ⩾40 in 27, 99, 59, 28 and 37 patients, respectively; including 26, 92, 45, 16 and 18 Child-Pugh A patients and 1, 8, 14, 11, and 17 Child-Pugh B patients, respectively. Survival times from the start of PBT were compared between Child-Pugh A and B patients, and among each ICG group.ResultsThe median survival times were 61 months (95% CI: 50–72 months) in all patients, and 64 and 20 months in Child-Pugh A and B patients, respectively (p = 0.001), The 3-year survival rates were 72%, 72%, 75%, 63%, and 26% in patients with ICG scores of 0–<10, 10–<20, 20–<30, 30–<40, and ⩾40 (p = 0.001); 70%, 75%, 77%, 65%, and 38% in these respective groups in Child-Pugh A patients (p = 0.02); and 100%, 57%, 67%, 36%, and 14% in Child-Pugh B patients (p = 0.173, not significant). Multivariate analysis showed that low ICG R15 and the absence of portal vein tumor thrombus were associated with good survival.ConclusionsPretreatment ICG R15 is a useful prognostic factor for prediction of outcome of PBT in HCC patients, especially in those with Child-Pugh A liver function.     

吲哚菁绿联合纳米炭双示踪技术在腔镜甲状腺乳头状癌手术中的应用

目的:探讨吲哚菁绿（indocyanine green,ICG）联合纳米炭（carbon nanoparticles,CN）在腔镜甲状腺乳头状癌（papillary thyroid carcinoma,PTC）手术中的临床疗效。方法:将经胸乳入路行腔镜PTC手术的102例患者随机分为三组。单纯ICG组（n=33）术中显露甲状腺后于外周静脉注射ICG。根据静脉注射ICG正显影甲状旁腺,负显影淋巴结原理。在荧光腔镜系统下寻找荧光显影的甲状旁腺,并切除无荧光显影的中央区淋巴结。单纯CN组（n=32）术中显露甲状腺后于患侧腺体内注射CN混悬液。根据腺体内注射CN正显影淋巴结,负显影甲状旁腺原理。在腔镜下将黑染的中央区淋巴结和脂肪组织切除,保留负显影不染色的甲状旁腺。ICG+CN组（n=37）,结合上述两组方法,利用双方的优势,双示踪、双识别,在腔镜下保留甲状旁腺,切除中央区淋巴结。比较三组患者的临床资料、手术相关指标、术后相关并发症等。结果:ICG+CN组较单纯ICG组及CN组在手术时间、清扫中央区淋巴结个数及中央区淋巴结转移个数方面表现更优,具有统计学差异（P＜0.05）;而ICG+CN组、单纯ICG组在暂时性甲状旁腺功能减退方面均优于单纯CN组,具有统计学差异（P＜0.05）。结论:通过外周静脉注射ICG和腺体内注射CN两者相结合的双示踪技术指导腔镜PTC手术,取得了较满意的临床疗效,还为临床实践提供了理论依据。     

4种评分系统预测肝细胞癌患者经肝动脉化疗栓塞术后肝衰竭的价值

目的:探讨Child-Pugh(CTP)、ALBI、MELD、MELD-Na评分预测肝细胞癌(hepatocellular carcinoma,HCC)经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗后并发慢性加急性肝衰竭(acute-on-chronic liver failture,ACLF)的价值。方法:回顾性分析2013月10月至2015年10月广西医科大学附属肿瘤医院接受首次TACE治疗的711例HCC患者的临床资料,采用Logistic回归分析及受试者工作特征(receiver operating characteristic,ROC)曲线评估4种评分模型预测ACLF的价值。结果:单因素、多因素分析结果均提示4种评分模型能独立预测TACE术后ACLF的发生(均P<0.05);ROC曲线分析显示,ALBI的受试者工作特征曲线下面积(area under curve,AUC)均显著高于其余三种评分的AUC(均P<0.001)。不同分型ACLF按4种评分模型的最佳截断(cut-off)值分组后,Chil...     

Clinical significance of cachexia index in patients with hepatocellular carcinoma after hepatic resection

BackgroundCancer cachexia has been associated with unfavorable outcomes in several malignancies. The cachexia index (CXI), which consists of skeletal muscle, inflammation, and nutritional status, has been proposed as a novel biomarker of cachexia. Therefore, we here investigated prognostic value of the CXI in patients with hepatocellular carcinoma (HCC) after hepatic resection.MethodsThe study comprised 213 patients who had undergone primary hepatic resection for HCC between 2008 and 2018. First, the skeletal muscle index (SMI) was calculated as the area of the psoas muscle at the third lumbar vertebra/(the height)². The CXI was then calculated by the following formula: SMI x serum albumin level/neutrophil-to-lymphocyte ratio (NLR). We retrospectively investigated the relationship between the CXI and disease-free survival as well as overall survival.ResultsIn multivariate analyses, female (p < 0.01), hepatitis B surface antigen-positivity (p < 0.01), preoperative serum alpha-fetoprotein level ≥20 ng/mL (p = 0.01), preoperative serum protein induced by vitamin K absence or antagonist-II level ≥200 mAU/mL (p = 0.02), multiple tumors (p < 0.01), macrovascular invasion (p = 0.04), type of resection (p < 0.01), and low CXI (p = 0.03) were significant predictors of disease-free survival, while Child-Pugh grade B (p < 0.01), poor tumor differentiation (p = 0.05), multiple tumors (p = 0.01), macrovascular invasion (p = 0.04), NLR (p = 0.04), and low CXI (p < 0.01) were significant predictors of overall survival. In the subgroup analysis of advanced T stage, the CXI was associated with both disease-free (p < 0.01) and overall survival (p = 0.06).ConclusionsThe CXI can be a prognostic indicator in patients with HCC after hepatic resection, suggesting the importance of comprehensive biomarker which includes skeletal muscle, inflammation, and nutritional status.