乙肝相关性肝癌肝脏储备功能评估方案的初步探讨

目的:探讨适合我国乙肝相关性肝癌肝切除患者的肝脏储备功能的评估方案。方法:回顾性分析连续129例因乙肝相关性肝癌行肝部分切除术患者的临床资料,比较3种经典的肝脏储备功能评估方案预测术后肝衰竭发生的特异性与敏感性。结果:全组共有13例(10.1%)患者术后发生肝衰竭(肝衰竭组),其中1例院内死亡;116例术后术后肝功能恢复良好(肝功能恢复良好组)。肝衰竭组患者行大块肝切除比例、术前吲哚青绿15 min滞留率(ICGR15)及年龄明显高于术后肝功能恢复良好组(均P0.05)。ICGR15评估方案与决策树(Decision Tree)评估方案均具有评估价值(均P0.01)。而Decision Tree评估方案预测术后肝衰竭的敏感性、特异性、阳性预测值及阴性预测值分别为95%,84%,64%和98%,均优于ICGR15评估方案。结论:Decision Tree方案适用于乙肝相关性肝癌肝切除患者的肝脏储备功能评估。

Liver functional reserve estimation in hepatitis B virus-related hepatocellular carcinoma: a preliminary study of three methods

Objective: To investigate a method of liver functional reserve estimation suitable for Chinese patients with hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC) before hepatectomy. Methods: The clinical data of 129 consecutive patients with HBV-related HCC undergoing partial hepatectomy were retrospectively analyzed,and then the specificities and sensitivities of three classical methods of liver functional reserve estimation for predicting posthepatectomy hepatic failure were compared. Results: Of the patients,13 cases(10%) developed liver failure and one died in hospital.The proportion of patients undergoing major hepatectomy,age and indocyanine green retention rate at 15 min(ICGR15) of the group with liver failure were significantly higher than those in the other group with good recovery of liver function(all P<0.05).The Decision Tree and the ICGR15 method had significant value for liver functional reserve estimation(both P<0.01).The sensitivity,specificity,the positive predictive value and the negative predictive value of decision tree method were 95%,84%,64% and 98%,respectively,which were all better than those of ICGR15 method. Conclusion: The Decision Tree is a suitable method for liver functional reserve estimation before hepatectomy in patients with HBV-related HCC.