肝切除术后第3天ICG-R15对肝细胞肝癌术后肝功能不全的预测价值

目的:探讨术后第3天吲哚菁绿15 min潴留率(ICG-R15)预测肝细胞肝癌术后肝功能不全发生的价值。方法:回顾2015年1月—2016年2月期间行肝切除的119例肝细胞肝癌患者资料,分析患者术后肝功能不全的发生与术前及术后第3天ICG-R15的关系,并比较术前与术后ICG-R15在预测术后肝功能不全发生的差异。结果:119例患者中共有33例(27.7%)术后发生肝功能不全。发生与未发生肝功能不全患者术前ICG-R15平均值分别为9.7%、5.2%,术后第3天ICG-R15平均值分别为11.8%、5.3%,术前与术后ICG-R15在发生与未发生肝功能不全患者间差异均有统计学意义(均P0.05)。分层分析显示,术后肝功能不全的发生率均随术前或术后第3天的ICG-R15增加而升高,且均在ICG-R1510%与20%的患者间有明显统计学差异(均P0.05)。术后第3天ICG-R15预测术后肝功能不全发生的ROC曲线下面积较术前ICG-R15大,前者的临界值为7.75(灵敏度为66.7%,特异度为83.7%),后者为3.35(灵敏度为84.8%,特异度为46.5%)。结论:术后第3天ICG-R15与术前ICG-R15一样可预测肝细胞肝癌术后肝功能不全的发生,且可能优于术前ICG-R15。

Value of ICG-R15 on postoperative day 3 in predicting liver dysfunction after hepatectomy for hepatocellular carcinoma

Objective: To investigate the value of indocyanine green retention test at 15 minutes (ICG-R15) on postoperative day (POD) 3 in predicting the occurrence of liver dysfunction after hepatectomy for hepatocellular carcinoma (HCC). Methods: The clinical data of 119 HCC patients undergoing hepatectomy from January 2015 to February 2016 were reviewed. The relations of the occurrence of postoperative liver dysfunction with preoperative and POD 3 ICG-R15 were analyzed, and the difference in predicting the occurrence of postoperative liver dysfunction between preoperative and POD 3 ICG-R15 was also compared.Results: Postoperative liver dysfunction occurred in 33 (27.7%) of the 119 patients. In patients with and without liver dysfunction, the average preoperative ICG-R15 was 9.7% and 5.2%, and POD 3 ICG-R15 was 11.8% and 5.3% respectively, and either the preoperative or POD 3 ICG-R15 was significantly different between patients with and without liver dysfunction (both P<0.05). Results of stratified analysis showed that the incidence of postoperative liver dysfunction was increased with the elevation of either preoperative or POD 3 ICG-R15, with statistical difference noted between patients with ICG-R15<10% and >20% (both P<0.05). The area under the curve of ROC of POD 3 ICG-R15 for prediction of preoperative liver dysfunction was larger than that of preoperative ICG-R15, and the cut-off value for the former was 7.75 (sensitivity: 66.7%; specificity: 83.7%) and for the latter was 3.35 (sensitivity: 84.8%; specificity: 46.5%), respectively. Conclusion: POD 3 ICG-R15 can be used for predicting liver dysfunction after hepatectomy for HCC similar to that of preoperative ICG-R15, and may even be superior to the latter.