PDF下载 ( 1671 KB)
Value of continuous monitoring of ICG-R15 in assessing hepatic insufficiency after partial hepatectomy
-
摘要: 目的探讨手术结束即时、术后3、5 d的吲哚菁绿15 min潴留率（ICG-R15）对肝部分切除术后肝功能不全发生的评估价值。方法前瞻性研究对象选取天津市第一中心医院肝胆外科2016年11月-2017年5月行肝部分切除术的肝癌患者70例。分析患者术前及术后连续性监测ICG-R15水平与术后肝功能不全的发生关系,对比术前及术后连续性监测ICG-R15在评估术后肝功能不全发生率之间的差别。计数资料组间比较采用χ2检验;计量资料组间比较采用两独立样本t检验;术前、术后连续性监测ICG-R15预估术后肝功能不全发生的准确性采用受试者工作特征曲线下面积（AUC）进行分析。结果 70例患者中术后发生肝功能不全14例,术后肝功能恢复良好56例,肝功能不全发生率20.0%。肝功能良好组中术前以及术后即时、3、5 d的ICG-R15平均值分别为（5.73±4.31）%、（12.36±7.41）%、（11.51±8.76）%、（9.60±7.00）%;肝功能不全组的术前以及术后即时、3、5 d的ICG-R15平均值分别为（18.02±13.48）%、（32.54±18.67）%、（34.73±18.49）%...Abstract: Objective To investigate the value of indocyanine green retention rate at 15 minutes ( ICG-R15) immediately and at 3 and 5 days after partial hepatectomy in assessing the incidence of postoperative hepatic insufficiency. Methods This prospective study included70 patients with hepatocellular carcinoma who underwent partial hepatectomy from November 2016 to May 2017 in the First Central Hospital of Tianjin. The relationship between preoperative and postoperative ICG-R15 and postoperative hepatic insufficiency was analyzed, and the difference between the preoperative and postoperative continuous monitoring of ICG-R15 in assessing the incidence of postoperative hepatic insufficiency was also analyzed. Comparison of categorical data was made by chi-square test. Continuous data were compared using two-independent-samples t test. The area under the receiver operating characteristic curve ( AUC) was used to determine the accuracy of preoperative and postoperative ICG-R15 in assessing the incidence of postoperative hepatic insufficiency. Results Of the 70 patients, 14 ( 20%) had postoperative hepatic insufficiency, and the other patients had good recovery of liver function. The means of ICG-R15 before operation and immediately and at 3 and 5 days after operation were 5. 73% ± 4. 31%, 12. 36% ± 7. 41%, 11. 51% ± 8. 76%, and 9. 60%± 7. 00%, respectively, in the patients with good recovery of liver function, and were 18. 02% ± 13. 48%, 32. 54% ± 18. 67%, 34. 73%± 18. 49%, and 25. 34% ± 11. 49%, respectively, in the patients with postoperative hepatic insufficiency, with significant differences between the two groups of patients ( t = 3. 368, 3. 966, 4. 571, and 4. 901, all P < 0. 05) . The incidence rates of postoperative hepatic insufficiency were 11. 10%, 20. 0%, and 100%, respectively, in patients with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 >20% preoperatively, were 0, 18. 2%, and 62. 5%, respectively, in patients with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 > 20% immediately after operation, were 6. 3%, 11. 1%, and 50. 0%, respectively, in patients with ICG-R15 < 10%, 10%
20% at 3 days after operation, and were 5. 3%, 12. 5%, and 62. 5%, respectively, in patients with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 > 20% at 5 days after operation; the incidence of postoperative hepatic insufficiency increased significantly as ICG-R15 increased ( χ2= 22. 374, 28. 024, 14. 810, and 21. 159, all P < 0. 001) . There were significant differences in the incidence of postoperative hepatic insufficiency between any two of the groups with ICG-R15 < 10%, 10% < ICG-R15< 20%, and ICG-R15 > 20% preoperatively ( all P < 0. 001) , and between any two of the groups with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 > 20% ( except ICG-R15 < 10% and 10% < ICG-R15 < 20% groups) before operation and at 3 and 5 days after operation ( all P < 0. 05) . The AUCs ( confidence intervals) of ICG-R15 before operation and immediately and at 3 and 5 days after operation were 0. 790 ( 0. 676-0. 878) , 0. 857 ( 0. 752-0. 929) , 0. 855 ( 0. 750-0. 927) , and 0. 870 ( 0. 768-0. 938) , respectively, and the postoperative ICG-R15 values had a significantly larger AUC than the preoperative ICG-R15 ( all P < 0. 05) . Conclusion Postoperative continuous monitoring of ICG-R15 is more accurate than preoperative ICG-R15 in assessing the incidence of hepatic insufficiency among liver cancer patients after partial hepatectomy, and can guide clinicians to provide early clinical intervention. -
Key words:
- liver neoplasms /
- hepatectomy /
- hepatic insufficiency /
- liver function tests /
- indocyanine green /
- prognosis
-
[1]ZHANG J, ZHOU XM.Disease assessment and prognosis of liver failure[J].J Clin Hepatol, 2016, 32 (9) :1673-1677. (in Chinese) 张静, 周新民.肝衰竭的病情评估及预后判断[J].临床肝胆病杂志, 2016, 32 (9) :1673-1677. [2]LIU JH, LIU N, LIU CX.Clinical value of indocyanine green retention rate in condition analysis and prognostic evaluation of patients with HBV-related acute-on-chronic liver failure[J].J Clin Hepatol, 2016, 32 (11) :2155-2158. (in Chinese) 刘精华, 刘娜, 刘晨希.吲哚菁绿15分钟滞留率对HBV相关慢加急性肝衰竭患者病情及预后的评估价值[J].临床肝胆病杂志, 2016, 32 (11) :2155-2158. [3]RAHBARI N, GARDEN OJ, PADBURY R, et al.Posthepatectomy liver failure:a definition and grading by the International Study Group of Liver Surgery (ISGLS) [J].Surgery, 2011, 149 (5) :713-724. [4]MOTOYAMA H, KOBAYASHI A, YOKOYAMA T, et al.Liver failure after hepatocellular carcinoma surgery[J].Langenbecks Arch Surg, 2014, 399 (8) :1047-1055. [5]SHI HJ, JIN C, FU DL.Preoperative evaluation of pancreatic ductal adenocarcinoma with synchronous liver metastasis:diagnosis and assessment of unresectability[J].World J Gastroenterol, 2016, 22 (45) :10024-10037. [6]NANASHIMA A, ABO T, ARAI J, et al.Comprehensive predictors of portal pressure from functional liver reserve in patients who underwent hepatectomy[J].Indian J Surg, 2015, 77 (Suppl 3) :923-929. [7]HAEGELE S, REITER SI, WANEK D, et al.Perioperative noninvasive indocyanine green-clearance testing to predict postoperative outcome after liver resection[J].PLo S One, 2016, 11 (11) :e0165481. [8]PIND MLL, BENDTSEN F, KALLEMOSE T, et al.Indocyanine green retention test (ICG-r15) as a noninvasive predictor of portal hypertension in patients with different severity of cirrhosis[J].Eur J Gastroenterol Hepatol, 2016, 28 (8) :948-954. [9]AHMAD B, TURKMANI K, MARWA ME, et al.Perioperative liver function after hepatectomy in a tertiary university hospital in damascus[J].Asian Pac J Cancer Prev, 2017, 18 (8) :2109-2113. [10]HAN H, HU H, XU YD, et al.Liver failure after hepatectomy:a risk assessment using the pre-hepatectomy shear wave elastography technique[J].Eur J Radiol, 2017, 86:234-240. [11]XU LN, XU YY, GAO DW.Impact of operative and peri-operative factors on the long-term prognosis of primary liver cancer patients undergoing hepatectomy[J].Huazhong Univ Sci Technol Med Sci, 2016, 36 (4) :523-528. [12]TAKAHASHI K, KUROKAWA T, OSHIRO Y, et al.Postoperative decrease in platelet counts is associated with delayed liver function recovery and complications after partial hepatectomy[J].Tohoku J Exp Med, 2016, 239 (1) :47-55. [13]HAYASHI H, BEPPU T, OKABE H, et al.Functional assessment versus conventional volumetric assessment in the prediction of operative outcomes after major hepatectomy[J].Surgery, 2015, 157 (1) :20-26. [14]LI FW, LEI ZQ, ZHANG QQ, et al.Establishment of nomogram model for predicting posthepatectomy liver failure in patients with HBV-related hepatocellular carcinoma[J/CD].Chin J Hepatic Surg:Electronic Edition, 2017, 6 (5) :358-362. (in Chinese) 李风伟, 雷正清, 张茜茜, 等.预测HBV相关肝细胞癌肝切除术后肝衰竭列线图模型的建立[J/CD].中华肝脏外科手术学电子杂志, 2017, 6 (5) :358-362. [15]LIU YH, WANG LM, WU JX, et al.A prospective pilot study of combined intra-operative radiotherapy for centrally located hepatocellular carcinomas[J].Chin J Oncol, 2017, 39 (12) :926-930. (in Chinese) 柳云贺, 王黎明, 吴健雄, 等.中央型肝细胞癌联合术中瘤床放疗的前瞻性初步研究[J].中华肿瘤杂志, 2017, 39 (12) :926-930. [16]HALLE BM, POULSEN TD, PEDERSEN HP.Indocyanine green plasma disappearance rate as dynamic liver function test in critically ill patients[J].Acta Anaesthesiol Scand, 2014, 58 (10) :1214-1219. [17]HIRAYAMA Y, IINUMA Y, YOKOYAMA N, et al.Near-infrared fluorescence cholangiography with indocyanine green for biliary atresia.Real-time imaging during the Kasai procedure:a pilot study[J].Pediatr Surg Int, 2015, 31 (12) :1177-1182. 期刊类型引用(9)
1. 刘养岁，张昕辉，李正臣，齐敦峰，李欢送. 荧光胆道显影在腹腔镜复杂胆囊切除术中的应用. 中国现代医学杂志. 2021(07): 69-73 . 
百度学术2. 罗志江，彭涛，林旋，陈斌. 术前肝功能评估指标的临床应用及研究进展. 中国普外基础与临床杂志. 2021(07): 962-968 . 百度学术3. 肖宇，程明亮，罗新华. 吲哚菁绿清除实验在原发性肝癌外科手术中的应用研究进展. 现代医药卫生. 2020(10): 1503-1506 . 百度学术4. 王宇，脱红芳，彭彦辉. 吲哚菁绿在肝切除围手术期的临床应用. 肝胆胰外科杂志. 2020(05): 313-316 . 百度学术5. 帕成周，邬善敏. 肝功能评价指标的临床应用进展. 疑难病杂志. 2020(06): 640-643 . 百度学术6. 黄荣晖. 前白蛋白与维生素D水平变化与肝癌患者术后不同分级肝功能代偿不全的相关性研究. 中外医学研究. 2020(29): 47-49 . 百度学术7. 吴喆，周健. 吲哚菁绿清除试验在肝脏疾病中的应用进展. 中国临床研究. 2020(11): 1586-1590 . 百度学术8. 马晓飞，焦彦如，王敏，周翰宗，张俊杰. 吲哚菁绿在腹腔镜下胆囊切除术中的应用与体会. 实用医技杂志. 2020(11): 1502-1503 . 百度学术9. 张明明，张岭漪. 吲哚菁绿清除试验评估肝储备功能的应用价值. 临床肝胆病杂志. 2019(08): 1878-1881 . 
本站查看其他类型引用(6)
-
百度学术
下载:
