应用ASGPR相关指标结合ICGR15建立肝脏储备功能定量评估体系

目的应用肝脏去唾液酸糖蛋白受体(ASGPR)相关指标结合吲哚氰绿潴留率(ICGR15)综合建立肝脏储备功能的定量评估体系.方法测定大鼠模型肝脏功能残余量及其肝脏ASGPR的HH15、LHL15和MRI结合ICGR15,建立一个以肝脏功能残余量(Y)为因变量,HH15、LHLi5、MRI和ICGR15为自变量的肝脏储备功能的综合定量评估体系.结果肝脏功能残余量Y值比HH15、LHL15、MRI、ICGR15等任何一个指标都敏感地反映出肝脏储备功能的变化.结论涵盖HH15、LHL15、MRI及ICGR15等指标的回归方程Y=2.56+33.188×MRI-44.844×HH15+24.032×LHL15-34.915×ICGR15中的Y值是评估肝脏储备功能的敏感指标,能够对肝脏储备功能作出准确可行的定量评估.     

单中心125例肝癌合并肝硬化患者术前肝脏储备功能评估的临床价值

目的 探讨Child-Pgh分级和吲哚氰绿(ICG)15分钟潴留率(ICGR15)在肝癌合并肝硬化患者术前肝脏储备功能评估中的临床价值.方法 回顾性分析125例经开腹手术和消融手术治疗的肝癌合并肝硬化患者的临床资料,根据ChildPugh分级与ICGR15水平分组,总结围手术期死亡率.结果 开腹手术治疗组105例,全组...     

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。     

肝脏储备功能的检测

肝脏外科取得快速发展,肝脏在解剖学上复杂性,已不再足肝脏外科学发展的瓶颈.限制肝脏手术的瓶颈是肝脏功能储备的极限,常使外科医生感到闲惑甚至束手无策.近来在肝功能储备研究方面,取得重大进展,本文综述国内外文献从肝切除量、术后肿瘤复发、肝移植、肝功能哀竭及肝脏储备功能检测等方面,介绍肝脏储备功能检测办法及其对肝脏外科发展的意义.     

兔肝脏储备功能的实验研究

对４０只健康新西兰在白兔。连续腹腔注硫代乙酰胺６５天，建立慢性肝损伤动物模型，然后按不同比例行肝部分切除术，采用手术后自身对照和组间对照方法，测定手术前后吲哚氰氯１５分钟血中溜留率、过氧化脂质及常规肝脏功能检查，并进行统计分析。     

活体肝移植术后受体肝脏储备功能和体积变化研究

目的探讨活体肝移植受体围手术期常规肝功能指标、肝脏储备功能和肝脏体积增长动态变化及其与患者近期临床结局的关系。方法收集30例受体术前基本资料,对围手术期常规肝功能指标、吲哚氰绿(ICG)血浆清除率(K)、CT肝体积以及术后近期(3个月内)的并发症情况进行分析。结果供肝重和受体体重比(GRBW)为0.63%～1.43%。受体术中移植肝脏体积为(638±103)ml,术后7、30及90d移植肝脏体积分别增长至(1096±152)ml、(1163±138)ml及(1158±140)ml,均大于术中的体积(P0.001),但术后各时间点肝脏体积间差异均无统计学意义(P0.05)。受体术后3、7、30和90d的KICG值逐渐升高〔(0.177±0.056)/min、(0.183±0.061)/min、(0.200±0.049)/min及(0.209±0.050)/min〕,均高于术前值〔(0.123±0.067)/min〕,差异均有统计学意义(P=0.006,P=0.002,P0.001,P0.001)。以供体术前KICG值(0.228±0.036)/min为基线,受体术后3d和7d的KICG值低于基线值(P=0.004,P=0.015),而术后30d和90d的KICG值已接近基线值(P=0.355,P=0.915)。根据术后14d总胆红素值将受体分为肝功能良好组(n=23)和肝功能不全组(n=7),与肝功能良好组相比,肝功能不全组术后3d的KICG值明显降低(P=0.001)。结论术后7d是活体肝移植受体肝脏体积增长的活跃期;受体肝脏储备功能的恢复要早于体积的恢复。ICG排泄试验可作为活体肝移植术后受体移植肝功能及预后的早期预测指标。     

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。     

原发性肝癌患者术前肝储备功能的预测和术后评价

目的 运用脉动色素浓度法(PDD)测定吲哚氰绿潴留率(ICGR15)及有效肝脏血流量(EHBF)评估原发性肝癌患者术前肝脏的储备功能.方法 对55例原发性肝癌患者术前应用PDD法检测ICGR15和EHBF并根据ICGR15分为3组,并行Child-Pugh评分;根据术后肝功的恢复情况将患者分为肝功能恢复良好(G)、轻度不全(M)和重度不全组(S).分析ICGR15三组中术后肝功不全的发生率以及在不同肝功恢复组中ICGR15、EHBF与Child-Pugh评分比较.结果 术后肝功不全在ICGR15三组中的发生率差异具有统计学意义(P＜0.05);肝功恢复不同组间ICGR15、EHBF同Child-Pugh评分比较具有显著性差异(P＞0.05);在不同的Child-Pugh分级之间,ICGR15及EHBF值差异有统计学意义(P＜0.05).结论 ICGR15、EHBF比传统Child-Pugh评分可以更准确的评估肝储备功能并指导确定手术方案.     

吲哚菁绿试验评估肝脏良恶性疾病肝脏储备功能的应用现状及发展前景

吲哚菁绿清除试验能够较为准确地反映肝脏储备功能,可用于评估肝脏切除及介入术前肝脏损伤程度及储备功能,并可预估术后各种并发症的发生概率。本文对近年吲哚菁绿清除试验在肝脏良恶性疾病治疗中的应用现状及发展前景做一综述。     

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。     

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。     

术前肝储备功能评估的研究进展

肝切除是原发性或继发性肝脏肿瘤的首选治疗方法.尽管在过去的10年里,肝切除技术已经得到了相当大的改进,而肝功能衰竭仍然是最令人担心的并发症,尤其是合并肝硬化的患者.近年来,外科医生为了提高切除率还在不断地尝试着攻克解剖和肿瘤体积的束缚.因此,准确的术前肝脏储备功能评估对于肝胆外科技术的提高非常重要.     

Remnant liver function during surgery for extensive hepatic resection

True functional reserve of remnant liver should be determined at the same condition that contemplated hepatectomy has been performed, and this condition can be achieved before resection by temporary lamping of the inflow vessels of hepatic lobes to be removed. Using indocyanine green (ICG), the remnant liver function (RLF) was evaluated whether or not the method can be a useful indicator for or against hepatomy. In the study of healthy dogs, the RLF proved to be a reliable indicator to prospect hepatic failure which may occur after extensive resection of the liver. Then, the method was employed in nine patients who underwent 40 to 70 per cent hepatectomy. The results indicated that the RLF with ICG during surgery, if performed under stable hemodynamics, is a beneficial tool to decide the resectability in equivocal cases.     

Redox tolerance test: An indicator of preoperative hepatic functional reserve in liver diseases

Changes in the arterial ketone body ratio during oral glucose loading were observed preoperatively in 134 patients with liver disease, and these data were correlated with the pathology findings of liver tissue and the postoperative clinical course. It was found that the redox tolerance index (RTI) could serve as a quantitive indicator of the severity of the underlying chronic hepatic disease in patients with liver disease, and as a reliable indicator of preoperative hepatic functional reserve. When the RTI was 0.70 or more, the underlying hepatic disease was slight and there was good hepatic functional reserve; these patients could tolerate any type of hepatic resection. When the RTI was less than 0.70 and more than 0.5, the underlying hepatic disease was moderate and hepatic functional reserve was poor; if the RTI was less than 0.50, major hepatic resection could not be tolerated.     

Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test

Preoperative assessment of liver function and prediction of postoperative remaining functional liver parenchymal mass and reserve is of paramount importance to minimize surgical risk, especially in patients with hepatocellular carcinoma (HCC), the majority of whom have liver cirrhosis as a complication. We have established a decision tree for deciding the safe limit of hepatectomy based on three variables: whether ascites is present, the serum total bilirubin level, and the indocyanine green retention rate at 15 minutes (ICGR-15), an indicator of sinusoidal capillarization. In patients who show a sign of decompensated cirrhosis as reflected by an elevated bilirubin value or uncontrollable ascites, hepatectomy is not indicated. In patients without ascites and with normal bilirubin level, the ICGR-15 value becomes the main determinant for the resectability and hepatectomy procedure. Incorporation of ICGR-15 into the decision tree enables patients conventionally classified into Child–Turcotte–Pugh class A or score 5–6 to be subdivided into several groups in which various hepatectomy procedures are feasible: enucleation, limited resection, segmentectomy, mono- to bisectoriectomy, and trisectriectomy. During strict application of this decision tree to 1429 consecutive hepatectomies, of which 685 were performed on HCC patients, during the last 10 years, we encountered only a single mortality.