术后吲哚菁绿15min滞留率联合标准残肝体积对肝细胞癌术后肝功能不全的预测价值

发布时间：2018-07-31 18:56

【摘要】：目的:探讨术后第3天吲哚菁绿15 min滞留率(indocyanine green retention rate at 15 minutes,ICG R15)联合标准残肝体积(standard remnant liver volume,SRLV)对肝细胞癌术后肝功能不全的预测价值。方法:回顾性研究中南大学湘雅医院普通外科在2015年1月至2016年2月期间收治的61例肝细胞癌行肝部分切除术患者的临床资料,并将其分为肝功能良好组(n=40)与肝功能不全组(n=21),采用单因素分析筛选术后肝功能不全发生的危险因素,采用回归分析筛选术后肝功能不全的独立危险因素并建立回归方程,采用受试者工作特征(receiver operating characteristics,ROC)曲线分析单一的独立危险因素与联合的独立危险因素在术后肝功能不全诊断上的价值差异。结果:61例手术患者中共有21例发生术后肝功能不全,肝功能不全发生率为34.4%。术后肝功能良好组与肝功能不全组在手术时间、肝门阻断时间、肿瘤体积、切除肝体积方面差异均无统计学意义(均P0.05);而在术后ICG R15,术中出血量和SRLV上差异均有统计学意义(均P0.05)。术后ICG R15,术中出血量和SRLV是术后肝功能不全的危险因素。回归分析提示:术后ICG R15和SRLV是术后肝功能不全的独立危险因素,回归方程为logit(P)=1.277+0.140×术后ICG R15 5.125×SRLV。术后ICG R15联合SRLV的ROC曲线下面积大于单一的术后ICG R15和SRLV的ROC曲线下面积,分别为0.787,0.713和0.681。结论:术后第3天ICG R15和SRLV是术后肝功能不全的独立危险因素,联合两者建立的回归方程可以较好地预测术后肝功能不全的发生,其诊断价值可能优于单一的术后第3天ICG R15和SRLV。
[Abstract]:Objective: to investigate the predictive value of indocyanine green 15 min retention rate (indocyanine green retention rate at 15 minutes ICG R15) combined with standard residual liver volume (standard remnant liver volumette SRLV) for postoperative liver dysfunction in hepatocellular carcinoma (HCC). Methods: the clinical data of 61 patients with hepatocellular carcinoma undergoing partial hepatectomy in Xiangya Hospital of Central South University from January 2015 to February 2016 were retrospectively studied. The patients were divided into two groups: good liver function group (nf40) and liver insufficiency group (nnn21). The risk factors of postoperative hepatic insufficiency were screened by single factor analysis, and the independent risk factors of postoperative hepatic insufficiency were screened by regression analysis and the regression equation was established. The value of single independent risk factor and combined independent risk factor in the diagnosis of postoperative liver insufficiency was analyzed by using (receiver operating characteristics curve. Results there were 21 cases of postoperative liver insufficiency in 61 cases of operation. The incidence of liver insufficiency was 34. 4%. The time of operation, the time of hepatic hilus occlusion, the volume of tumor were found in the group of good liver function and the group of liver insufficiency after operation. There was no significant difference in the volume of liver after resection (P0.05), but in postoperative ICG R15, the volume of intraoperative bleeding and SRLV were significantly different (P0.05). Postoperative ICG R 15, intraoperative bleeding and SRLV were risk factors for postoperative liver dysfunction. Regression analysis showed that postoperative ICG R15 and SRLV were independent risk factors for postoperative hepatic insufficiency. The regression equation was logit (P) 1.277 0.140 脳 ICG R15 5.125 脳 SRLV. The area under the ROC curve of ICG R15 combined with SRLV was larger than that of the single ICG R15 and SRLV ROC curve after operation, which was 0.713 and 0.681respectively. Conclusion: ICG R15 and SRLV are independent risk factors for postoperative liver dysfunction on the third day after operation. Its diagnostic value may be superior to that of ICG R15 and SRLV on the third day after operation.
【作者单位】：中南大学湘雅医院普通外科;
【基金】：湖南省卫生与计划生育委员会科研项目(B2016101)~~
【分类号】：R735.7

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