肝硬化肝癌肝体积及肝储备功能测定对肝脏手术的意义
发布时间：2018-04-16 23:21
本文选题：肝功能储备 + 吲哚氰绿实验 ； 参考：《吉林大学》2014年硕士论文
【摘要】：目的 分析肝硬化肝癌病人的肝储备功能及肝脏体积与肝硬化肝癌术后并发症的产生及肝功能改变的关系，为肝脏手术提供临床参考。 资料与方法 对吉林大学中日联谊医院肝胆胰外科2012年2月至2013年12月在我院行肝脏切除术的40例肝硬化肝癌的患者进行回顾性分析。术前患者均行Child—Pugh肝功能分级评分（符合2004年中华外科学会肝胆外科学组修订的原发性肝癌外科治疗方案的选择[1]）。脉动色素浓度（PPD）法检测吲哚氰绿15分钟滞留率（ICGR15）。采用日本320排螺旋CT进行肝脏扫描，对获得的数据进行三维重建，测量肝脏体积切除率LVRR（Liver Volume Removal Rate）=（切除的肝脏体积—肿瘤体积）/（全肝体积—肿瘤体积）x100%。依据Child—Pugh肝功能分级评分系统,根据术后肝脏功能恢复情况分为肝功能A级（A组）：总胆红素34umol/L，白蛋白35g/L，凝血酶原时间延长4s，无腹水，，无肝性脑病。肝功能B级（B组）：34umol/L≤总胆红素≤51umol/L，35g/L≥白蛋白≥28g/L，4s≤凝血酶原时间延长≤6s，轻度腹水，1㧟2级肝性脑病。肝功能C级（C组）：51umol/L 总胆红素，白蛋白28g/L，6s凝血酶原时间延长，中度或重度腹水，3㧟4级肝性脑病。根据术后有无胸腔积液、腹腔积液、胆汁瘘、消化道出血、肾衰及肝衰等分为有并发症及无并发症组。 结果 当ICGR15≤15%时LVRR与术后并发症之间的相关性无显著统计学意义（P＞0.05）。当ICGR15在15%－20%之间时LVRR≤30%并发症的发生率明显少于LVRR＞30%组，有显著统计学意义（P＜0.05）。当ICGR15≥20%时LVRR与术后并发症之间的相关性无显著统计学意义（P＞0.05）。当ICGR15与LVRR值逐渐升高时患者术后肝脏功能状态亦随之变差，发生率亦随之增加。 结论 1、患者ICGR15≤15%时可耐受较大范围肝脏体积切除（LVRR30%）。 2、术前行肝体积及肝储备功能测定，准确计算残肝体积能有效的预防术后并发症的发生，减少肝功能损害。
[Abstract]:PurposeTo analyze the relationship between liver reserve function and liver volume in patients with liver cirrhosis and the postoperative complications and changes of liver function in patients with liver cirrhosis and liver cancer, and to provide clinical reference for liver surgery.Data and methodsFrom February 2012 to December 2013, 40 patients with liver cirrhosis and liver cancer underwent hepatectomy in Jilin University Sino-Japanese Friendship Hospital were retrospectively analyzed.All patients were assessed with Child-Pugh 's hepatic function grading before operation (according with the revised surgical treatment plan of primary liver cancer [1]) in 2004 by the Chinese Academy of surgery in Hepatobiliary surgery.The retention rate of indocyanine green for 15 minutes was determined by PPD method.The liver was scanned with 320 slice spiral CT in Japan. The obtained data were reconstructed and the liver volume resection rate (LVRR(Liver Volume Removal volume) was measured.According to the Child-Pugh grading system of liver function, according to the recovery of liver function after operation, liver function grade A was divided into group A: total bilirubin 34 umol / L, albumin 35 g / L, prothrombin time prolonged for 4 s, no ascites, no hepatic encephalopathy.In group B, the prothrombin time was prolonged for less than 6 seconds, and the prothrombin time was prolonged for less than 6 seconds in group B: 34 umol/ L 鈮
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