原发性肝癌肝切除病人肝储备功能的综合预测

目的 探讨多指标综合预测原发性肝癌肝切除病人的肝代偿功能的价值。方法将237例原发性肝癌肝切除术的病人按照术后肝功能恢复情况分为代偿良好（A）、代偿轻度不全（B）、代偿重度不全（C）三组，对照病人的术前常规肝功能、Child-pugh分级、OGTT曲线类型等因素进行综合分析。结果三组病人的年龄、术前常规肝功能ALT、AST、ALB无明显差异（P〉0．05）；A、B组病人的TBIL差异无统计学意义（P〉0．05），但C组与A、B组之间差异有显著性意义（P〈0．05）。Child-Pugh肝功能分级的预测准确率为57．6％。OGTT P1型预测术后肝功能代偿良好的准确率为80％；OGTTP2型预测的肝功能代偿不良或重度不良的准确率为76．3％；OGTTL型预测肝功能重度不良的准确率为60．9％结论术前综合应用Child-pugh分级、TBIL和OGTT能较准确地预测原发性肝癌病人肝切除术后肝脏代偿能力。

MULTIPLE FACTORS ON EVALUATION OF LIVER RESERVE FUNCTION AFTER HEPATECTOMY FOR THE PATIENTS WITH HEAPTOCELLULAR CARCINOMA

Objective To evaluate the possibility of multiple factors on evaluation of liver function reserve after hepatectomy for hepatocellular carcinoma. Methods The data of 237 patients with hepatocellular carcinoma (HCC) from january 1998 to june 2004 were studied. After operation the patients' liver function could be classified as good recovering(Grade A, n=135), funcation damage(Grade B, n=67)and liver servere damage(Grade C, n=35). Pre-operative liver function, Child-Pugh grouping and type of Oral glucose tolerance(OGTT) were analyzed. Result The recovery of liver function after hepatectomy was not apparently related to ALT?AST?ALB. TBIL and the type of OGTT were significant indicator. The predicitive accuracy of Child-Pugh was 57.6%. The predicitive accuracy of OGTTP1, P2 and L were 80%, 76.3% and 60.9%, respectively. Conclusion Combining use of Child-Pugh score, the type of OGTT and TBIL can forecast the liver function reserve after hepatectomy for HCC.