ICGR15联合PT及标准残肝体积预测肝癌患者术后肝功能恢复

目的 探讨术前吲哚氰绿15分钟滞留率（indocyanine green retention rate at 15min,ICGR15）联合术前凝血酶原时间（prothrombin time,PT）及标准残肝体积（standard remnant liver volume,SRLV）对预测肝癌患者术后肝功能代偿的作用.方法 对64例因大肝癌行肝切除术的患者进行研究,根据术后患者肝功能代偿情况分组,对术前生化检查及一般情况进行差异性分析.结果 轻度肝功能代偿不全组（50例）、中重度肝功能代偿不全组（14例）之间ICGR15、PT、SRLV有统计学意义（P＜0.05）;Logistic回归分析得到回归方程为：PLFPI =0.186 × ICGR15 ＋0.849×PT-0.007×SRLV-9.617.经过ROC分析PLFPI预测术后肝功能重度代偿不全的临界值为-0.33,其灵敏度为100％,特异度为87.10％.结论 术前ICGR15联合术前PT及标准残肝体积能够较好地预测肝癌患者术后肝功能代偿情况;以PLFPI＜-33作为预防大肝癌肝切除术后重度肝功能代偿不全的术后肝功能综合预测指数界限是可行的.

ICG clearance test combined with prothrombin time and standard remnant liver volume predict the recovery of postoperative liver function in patients with hepatocellular carcinoma

Objective To explore the preoperative ICG clearance test combined with preoperative prothrombin time and standard remnant liver volume in predicting the recovery of postoperative liver function in patients with hepatocellular carcinoma.Methods Sixty-four patients with large hepatocellular carcinoma underwent hepatic resection from 2010 January to 2013 February at Affiliated Hospital of Guilin Medical College were included in our study.The patients were divided into two groups based on the level of liver function compensation after hepatectomy.The differences of preoperative examination biochemical and general situation were analyzed;Logistic regression analysis and ROC analysis on the relationship between preoperative ICGR15,prothrombin time,standard residual liver volume and postoperative moderate to severe liver function decompensation group was analyzed.Results Between mild hepatic decompensation group and moderate to severe hepatic decompensation group,ICGR15,prothrombin time,standard remnant liver volume were statistically significant （P ＜ 0.05）.Logistic regression analysis got the regression equation：PLFPI =0.186 × ICGR15 ＋0.849 × PT-0.007 × SRLV-9.617.Through ROC analysis the critical value of PLFPI predict postoperative severe liver function decompensation is-33,with a sensitivity of 100％ and a specificity of 87.10％.Sensitivity is more obvious than the preoperative ICG15,prothrombin time and SRLV high.Conclusion Preoperative ICGR15 combined with preoperative prothrombin time,standard remnant liver volume can predict hepatic functional recovery in patients with hepatocellular carcinoma after operation; PLFPI ＜-0.33as the boundarie of postoperative liver function prediction index that can prevent the patients with hepatocellular carcinoma after hepatic resection to occur severe hepatic decompensation is feasible.