应用吲哚青绿试验与血栓弹力图替代去唾液酸糖蛋白受体分析定量评估肝储备功能

目的：应用吲哚青绿实验与血栓弹力图检测指标,替代肝细胞表面去唾液酸糖蛋白受体分析,建立肝储备功能定量评估系统,并与Child-Pugh评分进行比较,了解其在肝切除术患者肝储备功能评估中的临床应用价值。方法对2012年1月1日至12月31日于本科室行肝部分切除术肝占位病变的患者共55例,测量PHCASGPR＋、ICGR15、EHBF、R值与K值,建立以PHCASGPR＋为因变量（Y）, ICGR15、EHBF、R值与K值为自变量（Xn）的肝储备功能定量评估系统,与Child-Pugh评分进行比较,了解两种方法预测术后肝功能代偿情况的准确率。结果 Child-Pugh预测术后肝功能代偿良好准确率为56.67%,Y值预测术后肝功能代偿良好准确率为84.62%（χ2=5.374,P =0.020）;Child-Pugh预测术后肝功能代偿不全准确率为76.00%,Y值预测术后肝功能代偿不全准确率为96.55%（χ2=5.400,P =0.020）。结论建立的肝储备功能定量评估系统能够更全面评价肝切除患者围手术期肝储备功能。     

脉动色素浓度测定法行ICG清除试验检测肝储备功能的临床应用

目的介绍一种进行ICG清除试验检测肝储备功能的新方法-脉动色素浓度测定法(PDD法),评价其可行性和实用性。方法PDD法进行ICG清除试验检测44例原发性肝癌患者ICG 15分钟滞留率(R15)、血浆清除率(K值)及有效肝脏血流量(EHBF),分析这些指标与肝硬化以及Ch ild-Pugh分级之间的关系。结果PDD法能在6~8分钟内完成ICG清除试验检测。37例患者肝癌合并有不同程度的肝硬化,合并肝硬化组与未合并肝硬化组相比EHBF下降,但无统计学意义(P>0.05),K值明显下降,R15明显升高,差别具有统计学意义(P<0.05);随着Ch ild-Pugh分级的递增,EHBF、K值下降、R15升高在A、B、C级间均有显著性差异(P<0.05)。36例患者行手术治疗未出现严重术后并发症,术后恢复良好。结论PDD法是行ICG清除试验检测肝储备功能实用可行的理想方法;R15、K值、EHBF能很好的反映原发性肝癌患者的肝储备功能;K值、R15可能是更为敏感的指标。     

功能性残肝体积比联合ICG R15对选择性出入肝血流阻断肝切除术肝储备功能评估分析

目的探讨功能性残肝体积比联合吲哚氰绿15 min内滞留率(indocyanine green retention rate at 15 minute,ICG R15)评估选择性出入肝血流阻断肝切除术肝储备功能。方法回顾分析2012年8月至2015年7月对83例合并乙型肝炎后肝硬化行区域性出入肝血流阻断肝切除术的肝细胞癌病人资料。检测术前Child-Pugh分级评分、ICG R15和术后肝功能不全程度,行术前CT和术中排水法计算功能性残肝体积比(ratio of functional remnant liver volume,%RLV)。Child-Pugh评分分为A级、B级二组,ICG R15分为10%、10%~20%、20%三组,%RLV分为40%~60%、60%~80%、80%三组,术后肝功能不全程度分为轻度、中度、重度三组。在Child-Pugh评分基础上,%RLV联合ICG R15对比分析肝储备功能,χ~2检验和t检验分析差异性。结果不同肝功能不全组ICG R15组内差异有统计学意义(P0.05),%RLV组内差异有统计学意义(P0.01)。随着ICG R15递增和%RLV下降术后肝功能不全程度渐加重,差异有统计学意义(P0.05)。重度肝功能不全均发生于Child-Pugh B级。平均阻断时间为(17±12)min,阻断1次62例,间歇5 min阻断2次11例,阻断3次10例。术中平均出血量为(437±316)ml,围手术期无死亡病例。结论功能性残肝体积比联合ICG R15较Child-Pugh分级更精确预测选择性出入肝血流阻断肝切除术肝功能不全程度。     

吲哚氰绿排泄试验及标准余肝体积与肝癌切除术后肝功能不全的相关性研究

目的 结合吲哚氰绿(ICG)排泄试验及标准余肝体积探讨预防肝切除术后肝功能中、重度代偿不全的安全切肝界限.方法 对2007年3月至2008年2月期间收治的75例因肝癌行肝切除术的患者进行研究分析,根据术后肝功能代偿状况分组,将术后发生肝功能中度代偿不全患者术前ICG 15 min潴留率(ICGR15)值与术后标准余肝体积进行直线回归分析.结果 全部患者中,术后发生肝功能轻度代偿不全60例,中度代偿不全12例,重度代偿不全3例.轻度代偿不全组与中重度代偿不全组患者的年龄[(50±13)岁和(53±9)岁]、术前Child-Pugh评分[(5.4±0.6)分和(5.7±0.9)分]、凝血酶原时间[(13.6±1.0)s和(13.5±1.0)s]、国际标准化比值(1.09±0.10和1.06±0.10)等指标的差异均无统计学意义(P>0.05);而两组ICG排泄试验中的K值(0.20±0.04和0.17±0.03)和ICGR15值(6±4和9±4)以及术后标准余肝体积[(545±93)ml和(398±82)ml]的差异均有统计学意义(P<0.05).将术后肝功能中度代偿不全患者术前ICGR15值和术后标准余肝体积进行直线回归分析,发现两者呈正相关(R=0.640,P=0.025),回归方程为:标准余肝体积(ml/m~2)=1594.6×ICGR15+265.结论 将ICG排泄试验和标准余肝体积结合起来评估患者肝脏储备功能,有助于预测患者术后发生肝功能损害的程度及预防患者术后发生肝功能中、重度代偿不全.     

脉搏染料光密度法吲哚氰绿排泄试验对评价肝癌切除术后肝功能不全的价值

目的 探讨脉搏染料光密度法吲哚氰绿(PDD-ICG)排泄试验评估肝储备功能的价值.方法 对我院2007年3月至2008年2月间收治的75例因肝癌行肝切除术的患者行前瞻性研究,根据术后肝功能代偿情况分组,比较不同组间术前检查指标的差异; 并根据ICG清除率(K)值和ICG15 min储留率(R15)值再分别分组,比较各组间术后肝功能中重度功能障碍发生率的差异.结果 术后肝功能轻度功能障碍组60例,中度功能障碍组12例,重度功能障碍组3例(因重度功能障碍组例数过少,纳入中度功能障碍组行统计分析).轻度功能障碍组与中重度功能障碍组患者的年龄、术前Child-Pugh评分、PT及INR的差异均无统计学意义(P＞0.05); 2组间K值和R15值差异均有统计学意义(P<0.05).将K值以0.158/min为界分为2组, K<0.158/min组术后肝功能中重度功能障碍发生率为47.1%; K≥0.158/min组为12.1%,2组间差异有统计学意义(P<0.05).将R15值以10%为界分为2组, R15≤10%组术后肝功能中重度功能障碍发生率为15.9%; R15＞10%组为41.7%,2组间差异有统计学意义(P<0.05).结论 PDD-ICG试验评估肝切除术患者肝储备功能有效、简便,对预测患者术后发生肝功能损害的程度及避免患者术后发生肝功能衰竭有重要的临床指导作用.     

脉动色素浓度测定法行ICG清除试验检测肝储备功能的准确性评价

目的评价ICG清除试验检测肝储备功能的新方法——脉动色素浓度测定法（PDD法）的准确性。方法18例原发性肝癌病人采用PDD法行ICG清除试验测定ICG15分钟滞留率（R15）、血浆清除率（K），同时在推注ICG前、推注ICG后5、10、15min分别留取血样，采用传统分光光度法检测R15和K。两种方法检测的结果进行统计学分析，探讨两者之间的相关性和一致性。结果PDD法能在6～8min内完成ICG清除试验检测。PDD法和分光光度法检测的K值分别为（0．166±0．062）／min、（0．129±0．047）／min；检测的R15值分别为13．43％±11．64％、17．97％±12．49％；PDD法与分光光度法相比检测的K值升高，R15值降低，差异具有显著性意义（P〈0．05）。直线回归分析显示两种方法的检测结果具有较好的相关性，K值和R15的相关决定系数分别为0．9488和0．9508（P〈0．05）。Bland-Altman分析显示：K值和R15的平均偏差分别为0．036±0．0192／min和-4．53％±2．83％，平均偏差95％的分布范围分别为-0．001～0．074／min和-10．1％～1．0％，提示两种方法检测结果之间的一致性较差。结论（1）分光光度法检测费时，相对有创；而PDD法则可在微创的条件下快速检测K值、R15，同时还能检测有效肝脏血流量；（2）PDD法和分光光度法检测的结果有明显的差异，PDD法检测的结果可能更接近于标准值，准确性更高。     

吲哚氰绿测定和肝纤维化定量评估肝储备功能的研究

目的：探讨吲哚氰绿和肝纤维化定量测定对评价肝储备功能的价值。方法：制备大鼠肝硬化模型,测定吲哚氰绿15 min潴留率(R15ICG)并使用计算机辅助数字图像分析法检测肝纤维化程度。分析R15ICG与肝纤维化定量评估间的关系,以及两者与肝功能测定间的关系。结果：R15ICG和肝纤维化两指标在对照组、造模8周组和10周组之间差异有统计学意义（P＜0.01）。R15ICG和Child-Pugh评分系统与肝纤维化百分比之间呈直线正相关（r=0.75,0.533;P＜0.05）。结论：吲哚氰绿和肝纤维化定量评估肝功能是较好的指标;两者联合使用有助于全面评价肝脏功能状态。     

吲哚氰绿清除试验在半肝切除术中应用的价值

目的 探讨半肝切除术中测定吲哚氰绿15 min潴留率(ICGR15)在原发性肝癌手术中评估残余肝脏储备功能的价值.方法 44例原发性肝癌患者术中阻断待切除侧肝动脉和门静脉后,应用肝功能储备分析仪检测ICGR15.同时记录患者术前Child-Pugh评分、Child-Pugh分级及MELD评分,并评价患者术后肝功能恢复情况.结果 手术后共有17例患者出现肝功能不全,其中肝功能代偿轻度不全14例,重度不全3例.术中ICGR15<10%者术后肝功能不全发生率为17.9%(5/28),明显低于10%～15%者的75.0%(12/16),差异有统计学意义(P<0.05).Child-Pugh评分在肝功能恢复良好者、肝功能代偿轻度不全者和肝功能代偿重度不全者之间的差异无统计学意义(P>0.05); 而肝功能恢复良好者的ICGR15及MELD评分则明显低于肝功能代偿轻度和重度不全者(P<0.05).术前Child-Pugh A级者其术中ICGR15明显低于Child-Pugh B级者(P<0.05).结论 术中残余肝脏的ICGR15检测比传统的Child-Pugh评分更能准确地评估残余肝脏储备功能,可用于指导制定手术方案.     

术前应用靛氰绿检测联合三维重建成像评估肝门部胆管癌肝脏储备功能

目的探讨肝门部胆管癌患者肝切除术前肝脏储备功能的评估方法及意义。方法单治疗组手术的肝门部胆管癌患者72例。比较通过靛氰绿(ICG)检测、三维成像(3D)重建评估后手术患者并发症发生率。结果 72例患者中,67例患者行ICG检测,56例ICG 15分钟滞留率(R15)10%,11例ICG R1510%。3D重建评估预留肝体积为(860.32±235.41)cm3,预留脏脏体积/全肝体积为38%~75%。32例患者术前采用ICG联合3D重建。术后并发胆漏5例,腹腔积液11例,并发症发生率为22.2%。各组间术后并发症发生率悲剧差异有统计学意义(P0.05)。结论术前ICG检查联合3D重建评估可定量评价患者肝脏储备功能,做出准确手术规划,减少术后并发症。     

吲哚菁绿在肝切除围手术期的临床应用

术后肝功能不全、肝衰竭等并发症是影响肝癌患者手术方式及预后的重要因素。围手术期肝脏储备功能评估可早期识别肝脏潜在损伤,评价剩余肝功能,有助于分析肝切除患者的耐受、预后及恢复情况。吲哚菁绿（indocyanine green,ICG）清除试验可以检测正常肝细胞代谢总和,其测量的肝脏储备功能比血清生化检查更加准确,且具有动态性。近年来ICG在术前评估手术风险、指导术式选择,术中评估手术安全性,术后预测预后等方面的应用逐渐深入。本文就ICG在肝切除围手术期应用的最新进展进行综述。     

不同浓度七氟醚对肝脏清除功能和血流动力学的影响

目的采用脉搏染料光密度法评价不同浓度七氟醚麻醉对肝脏清除功能和血流动力学的影响。方法择期行妇科手术患者30例,年龄35~45岁,ASAⅠ或Ⅱ级,随机分为0.6 MAC组、1.0 MAC组和1.4 MAC组,每组10例。采用潮气量法吸入七氟醚麻醉,分别维持0.6 MAC、1.0 MAC和1.4 MAC稳定15 min。分别在麻醉诱导前15 min和呼气末七氟醚浓度稳定后15 min进行吲哚菁绿(ICG)清除试验,测定ICG清除率(K)、15 min滞留率(R15)、血浆半衰期(T1/2)、心排出量(CO)、心脏指数(CI)、每搏量(SV)和循环血容量(BV)、肝脏有效血流量(EHBF)、运氧量(DO2)和平均循环时间(MTT)。分析三组呼气末七氟醚浓度稳定后15 min时K与EHBF的相关性。结果与麻醉诱导前15 min比较,呼气末七氟醚浓度稳定后15 min时0.6 MAC组和1.4 MAC组BV明显升高(P<0.05),1.4 MAC组EHBF明显降低(P<0.05),三组K明显降低(P<0.05),R15明显升高(P<0.05),T1/2明显缩短(P<0.05)。三组K与EHBF在呼气末七氟醚浓度稳定后15 min具有明显线性正相关关系(P<0.05)。结论 0.6~1.4 MAC七氟醚麻醉可降低肝脏的清除功能,不影响正常肝脏储备功能,在此范围内无剂量相关性;其血流动力学保持相对稳定。     

气腹对肝硬化大鼠肝脏血流的影响

目的：探讨气腹压力下正常机体及肝硬化机体肝脏吲哚青绿排泄的变化及气腹对肝脏血流的影响。方法：雄性Wistar大鼠30只,随机分成5组,其中2组用60％四氯化碳皮下注射加5％乙醇口服的方法建立肝硬化模型。同期对5组进行吲哚青绿15min排泄试验：正常麻醉组、正常开腹组、正常气腹组、肝硬化麻醉组、肝硬化气腹组。结果：5组分别测得血清吲哚青绿含量,正常开腹组（0．662μg/ml）虽高于正常麻醉组（0．645μg/ml）,但差异无显著意义（P＞0．05）;正常气腹组（0．967μg/ml）显著高于麻醉组及开腹组（P＜0．05）;而肝硬化麻醉组（1．198μg/ml）和肝硬化气腹组（1．348μg/ml）均显著高于正常3组（P＜0．05）;肝硬化气腹组又显著高于肝硬化麻醉组（P＜0．05）。结论：气腹使吲哚青绿排泄降低的结果,证实了腹腔镜手术中的气腹压力可减少肝脏血流量,对于肝硬化机体更有临床意义。     

吲哚菁绿排泄试验预测肝切除术后肝功能衰竭的价值

目的 探讨吲哚菁绿排泄试验预测肝切除术后肝功能衰竭的价值.方法 回顾性分析2007年6月至2008年6月安徽省立医院128例行肝切除患者的临床资料.按照术后是否发生肝功能衰竭分为无肝功能衰竭组(110例)和肝功能衰竭组(18例).应用脉动色素浓度法测定吲哚菁绿15 min滞留率(ICG R15)和有效肝血流量(EHBF),进行肝功能Child评分、组织活性指数评分(HAI评分),并检测临床生化指标及其他相关指标,分析各指标与术后肝功能衰竭的关系以筛选阳性预测指标.采用t检验、x2检验、线性回归分析或Logistic回归模型分析检测数据.结果 无肝功能衰竭组ICG R15、肝功能Child评分、HAI评分分别为9%±4%、(5.6±0.7)分、(3.8±0.5)分,明显低于肝功能衰竭组的15%±6%、(6.1±0.8)分、(5.0±0.8)分;而无肝功能衰竭组EHBF为(1.2±0.2)L/min,明显高于肝功能衰竭组的(1.0±0.2)L/min(t=11.121,2.356,3.915,2.802,P＜0.05).年龄≥65岁、ICG R15≥14%和EHBF＜1.0 L/min是肝切除术后发生肝功能衰竭的危险因素(x2=4.758,9.709,5.362,P＜0.05).ICG R15与EHBF呈负相关(r=-0.527,P＜0.05);HAI评分与ICG R15呈正相关(r=0.638,P＜0.05),与EHBF呈负相关(r=-0.445,P＜0.05).结论 ICG R15和EHBF是预测肝切除术后肝功能衰竭的良好指标.ICG R15≥14%和EHBF＜1.0 L/min时行肝切除则患者术后更有可能发生肝功能衰竭.

Abstract：

Objective To assess the value of indocyanine green excretion test in predicting hepatic failure after hepatectomy. Methods The retention rate of indocyanine green at 15 minutes (ICG R15), effective hepatic blood flow (EHBF) and clinical and biochemical parameters of 128 patients who received hepatectomy at the Affiliated Provincial Hospital of Anhui Medical University from June 2007 to June 2008 were detected by pulse dye densitometry. All patients were divided into non-hepatic failure group (n = 110) and hepatic failure group (n =18). ICG R15, EHBF, Child's score, histology activity index (HAI) score, clinical and biochemical parameters and other indexes were analyzed to predict hepatic failure by the t test, chi-square test, linear regression analysis or regression model. The relationship between positive predictive indexes and HAI score was studied. Results Eighteen patients suffered from hepatic failure after operation. ICG R15, Child's score, HAI score of patients without hepatic failure were 9% ±4%, 5.6 ±0.7, 3.8 ±0.5, which were significantly lower than 15% ±6%,6.1 ± 0. 8, 5.0 ± 0. 8 of patients with hepatic failure (t = 11. 121,2. 356, 3. 915, P ＜ 0.05). EHBF of patients without hepatic failure was (1.2 ±0.2) L/min, which was significantly higher than (1.0 ±0.2) L/min of patients with hepatic failure (t = 2. 802, P ＜ 0. 05). In a logistic regression model, age ≥ 65 years, ICG R15 ≥ 14% and EHBF ＜ 1.0 L/min were risk factors of postoperative hepatic failure (x2 = 4. 758, 9.709, 5. 362, P ＜ 0.05).ICG R15 was negatively correlated with EHBF (r =-0. 527, P ＜0.05). HAI score was positively correlated with ICG R15 (r =0. 638, P ＜0.05), while it was negatively correlated with EHBF (r =-0. 445, P ＜0. 05).Conclusions ICG R15 and EHBF are good predictive indicators for hepatic failure after hepatectomy. Patients with ICG R15≥14% and EHBF ＜ 1.0 L/min are prone to have postoperative hepatic failure.     

Experimental study of liver dysfunction evaluated by direct indocyanine green clearance using near infrared spectroscopy.

BACKGROUND: Blood clearance of indocyanine green (ICG) is an objective test of liver function. Hepatic ICG clearance can now be measured directly using near infrared spectroscopy (NIRS). The aim of this study was to evaluate measurement of hepatic ICG clearance by NIRS in an animal model of acute hepatic dysfunction. METHODS: New Zealand white rabbits (n = 36) underwent laparotomy for liver exposure. Hepatic blood flow and microcirculation were measured along with hepatic ICG concentration by NIRS. Hepatic ICG clearance was measured in groups of six animals after reduction of the hepatic blood flow by hepatic artery occlusion and portal vein partial occlusion, lobar ischaemia and reperfusion (I/R), colchicine administration and bile duct ligation. Hepatic ICG uptake and excretion rates were calculated by a non-linear least square curve fitting method from the ICG concentration-time curve. RESULTS: There was a significant positive correlation between hepatic ICG rate of uptake and both hepatic blood flow and microcirculation (r = 0.79, P = 0.0001; r = 0.59, P = 0.005 respectively). I/R resulted in a significant reduction of both the rates of ICG uptake (mean(s.d.) 0. 85(0.59) min-1; P = 0.0002 versus control) and ICG excretion (0. 020(0.006) min-1; P = 0.02 versus control). Colchicine decreased the rate of hepatic ICG excretion (0.030(0.010) min-1; P = 0.02 versus control) as did bile duct ligation (0.002(0.001) min-1; P = 0.01 versus control). CONCLUSION: Measurement of hepatic ICG clearance by NIRS is a promising technique for assessing hepatic parenchymal dysfunction and may have application in liver surgery and transplantation.     

Effects of intravenous nicardipine, prostaglandin E1, nitroglycerin, sodium nitroprusside, and epidural lidocaine on hepatic and renal blood flow during hypotensive anesthesia

We studied the effects of intravenous nicardipine (NIC), prostaglandin E1 (PGE1), nitroglycerin (TNG), sodium nitroprusside (SNP) and epidural lidocaine (LID) on hepatic and renal blood flow during general anesthesia (nitrous oxide-oxygen-sevoflurane) in 46 female patients undergoing unilateral total hip arthroplasty. During operations, hepatic blood flow, glomerular filtration rate, renal plasma flow, and renal tubular injury were measured by R 15 ICG (15 minutes retention rate of indocyanine green), CCR (creatinine clearance), CPAH (para-aminohippuric acid clearance), and urinary excretion of NAG and beta 2-microglobulin. Significant elevation of R 15 ICG was observed in the hypotensive state in the TNG group and the elevation of R 15 ICG indicates that blood flow to the liver has decreased during hypotensive anesthesia. Urine volume in the PGE1 group was larger than that in the TNG, SNP or LID group. CCR in the PGE1 group was larger than that in the NIC, TNG or SNP groups. CPAH in the PGE1 group was larger than that in the SNP or LID group. The value of urine NAG in the TNG group was larger than that in the NIC or PGE1 group. The value of urine beta 2-microglobulin in the NIC group was larger than that in the PGE1 or SNP group. The results of urine volume, CCR, CPAH, urine NAG, and urine beta 2-microglobulin indicate that blood flow to the kidneys was greater in the PGE1 group as compared to other groups. This study indicates that prostaglandin E1 is the best hypotensive drug for hepatic and renal blood flow during hypotensive anesthesia.     

Assessment by pulse dye-densitometry indocyanine green (ICG) clearance test of hepatic function of patients before cardiac surgery: its value as a predictor of serious postoperative liver dysfunction.

OBJECTIVE: Patients with preoperative liver dysfunction occasionally have a poor prognosis after cardiac surgery because the liver condition is aggravated. The pulse dye-densitometry indocyanine green (ICG) clearance test was used as a preoperative evaluation technique. DESIGN: Prospective, clinical evaluation. SETTING: Surgical intensive care unit of a national cardiovascular center. SUBJECTS: Twenty-seven patients with preoperative liver dysfunction were studied. They were divided into four groups depending on the cause of their liver dysfunction. INTERVENTIONS: With the patient's informed consent, a bolus of ICG, 20 mg, was injected, and the disappearance of ICG was measured noninvasively by pulse dye-densitometry. MEASUREMENTS AND MAIN RESULTS: The ICG retention rate at 15 minutes (ICG-R15) was calculated for the regression time. The patients were assessed in terms of ICG-R15 and the cause of liver dysfunction. The ICG-R15 values obtained for all 27 patients were 30% +/- 16% (mean +/- standard deviation). The 21 survivors had ICG-R15 values of 24% +/- 12%, whereas the 6 patients who died after surgery had significantly greater ICG-R15 values of 50% +/- 13% (p < 0.05). The mean values of ICG-R15 in patients with congestive liver, viral hepatitis accompanied by congestive liver, viral hepatitis, and cirrhosis were 34%, 23%, 13%, and 42%, respectively. The 6 of 27 patients who died after surgery had ICG-R15 values greater than 40%. Five of the seven patients with cirrhosis died. CONCLUSION: These results suggest that (1) compared with Child-Pugh classification, the value of ICG-R15 provides a more accurate surgical indication; and (2) liver dysfunction from cirrhosis causes postoperative deterioration of liver function, especially when the ICG-R15 value exceeds 40%.     

气腹影响肝脏吲哚青绿排泄的实验研究

目的 腹腔镜手术中气腹对机体生理功能的一些影响是已知的。本研究以吲哚青绿（ICG）药代动力学参数作为肝脏血流指数,观察气腹时的变化情况。方法 雄性Wistar大鼠18只,随机分面三组：麻醉组、开腹组、气腹组。气腹压力为8mmHg,ICG（1mg/kg0股静脉给药,进行ICG15min排泄试验。结果 分别测得各组血清ICG含量,开腹组ICG水平虽高于麻醉组,但无统计学差异（P＞0.05）。而所腹组ICG水平显著高于麻醉组及开腹组（P＜0.05）。结论 所腹使ICG排泄降低的结果,证实了腹腔镜手术中气腹压力可减少肝脏血流量。     

Non‐invasive ICG‐clearance: a useful tool for the management of hepatic artery thrombosis following liver transplantation

Levesque E, Hoti E, Azoulay D, Adam R, Samuel D, Castaing D, Saliba F. Non‐invasive ICG‐clearance: a useful tool for the management of hepatic artery thrombosis following liver transplantation.
Clin Transplant 2011: 25: 297–301. © 2010 John Wiley & Sons A/S. Abstract: Background: The clinical presentation of hepatic artery thrombosis (HAT) post‐liver transplantation (LT) varies considerably. Doppler ultrasonography (Doppler US) is the first line investigation, with a diagnostic sensitivity for HAT as high as 92%. Because indocyanine green (ICG) elimination from the blood depends among other factors on the hepatic blood flow, we hypothesized that plasma disappearance rate of indocyanine green (PDR‐ICG) can be influenced by the flow in the hepatic artery. Thus, we evaluated the role of PDR‐ICG measurement in HAT diagnosis in post‐LT patients. Patients and methods: Fourteen liver transplant patients with no visible flow in the hepatic artery (Doppler US) were identified. Of the 14, seven patients had HAT confirmed by CT‐angiography. The PDR‐ICG measurement, an investigation routinely used in our center, was performed in all 14 patients. Results: The PDR‐ICG in patients with HAT was significantly lower than in patients without HAT (5.8 ± 4.3 vs. 23.8 ± 7.4%/min, p = 0.0009). In patients with HAT, after the revascularization, the PDR‐ICG value increased (5.8 ± 4.3 vs. 15.6 ± 3.5%/min, p = 0.006). Conclusion: The ICG elimination may be an adjunct diagnostic tool in the management of patients with suspected HAT following LT.     

肝癌切除术后吲哚菁绿清除率的变化及影响因素

目的：评估肝癌切除术后早期肝储备功能水平的变化趋势及影响因素。方法：选取2010年6—8月收治的肝癌患者12例,分别测定患者术前和术后第3、7天的血浆吲哚菁绿清除率（K）,分析手术前后K值的变化趋势。计算切除的肿瘤组织与肝实质的体积比,分析其与K值变化的相关性。结果：12例患者术前平均K值为0.180±0.049,术后第3天K值为0.151±0.044,显著低于术前水平（P〈0.01）。术后第7天K值0.167±0.060低于术前水平,但差异无统计学意义（P〉0.05）。术后第7天△K（K第7天-K术前）与切除的肿瘤体积/癌旁组织体积比正相关（r=0.845,P〈0.001）,但与切除的癌旁组织体积无明显相关（r=-0.143,P〉0.05）。结论：肝切除术后早期肝储备功能明显受损,损伤程度与肿瘤体积及肝切除范围有关。