应用脉动式分光光度法对肝切除围手术期肝功能改变及其相关因素的.DOC

应用脉动式分光光度法对肝切除围手术期肝功能改变及其相关因素的分析 张爱群 周宁新 赵向前 倪彬 张兰英 高丽杰 张文智 解放军总医院全军肝胆外科研究所 北京 100853 [摘要] 目的 用脉冲式分光光度法观察肝切除围手术期肝功能的变化，进一步研究此变化与肿瘤及被切除的肝组织体积之间的关系。方法 肝癌病人18例（31-67岁），分别于术前、术后第3天和第7天用脉动光密度仪测定血浆吲哚氰绿清除率（K）。病人接受常规的部分肝切除术，被切除的肝脏组织块和肿瘤本身的体积由水排法测定，肿瘤周围组织的体积为前两者之差。对术后ICG K值较术前的变化与肿瘤和肿瘤周围组织体积比，以及瘤周组织本身的体积之间进行了相关性分析。结果 肝部分切除后，ICG K 值由术前的0.192±0.021下降至术后第3天的0.135±0.019(P0.01), 术后第7天仍保持在一个较低的水平（0.144±0.025，P0.05），而术后两次的测得值之间没有明显差异。术后第7天ICG K值的变化与肿瘤和瘤周肝组织的体积比之间呈直线相关关系（r=0.845，P0.001），而与瘤周肝组织的体积之间则无显著相关性（r=-0.143, P0.05）。结论 肝癌病人肝部分切除术后K明显下降；与术前比较，术后K值的变化与肿瘤、丢失的正常肝组织体积之间的比值有关。 [关键词]：吲哚氰绿（ICG indocyanine green）脉动式分光光度法 肝切除术 Perioperative Liver Function in Hepatectomy and Its relationship with Resected Mass: a Preliminary Evaluation with ICG Pulse Spectrophotometry Ai-Qun Zhang, Ning-Xin Zhou, Xiang-Qian Zhao, Bin Ni, Lan-Ying Zhang, Li-Jie Gao, Wen-Zhi Zhang Institute of Hepatobilliary Surgery, Chinese PLA General Hospital, Beijing, 100853 [Abstract] Objective: To reevaluate the changes of liver function in early postoperative period after hepatectomy and its relationship with the size of tumor and resected liver tissue mass. Methods: Besides regular biochemical tests of blood samples, liver function reserve indicated by plasma clearance rate of ICG(K) was measured with pulse-dye densitometry before operation and 3, 7 days postoperatively in 18 patients aged 31-67 years, who were diagnosed as hepatocarcinoma and underwent liver resection of various extent. Volumes of resected tissue mass including tumor and its peripheral liver tissue were measured by displacing water ,and the volume of peripheral liver tissue was obtained as the total volume minus the tumor one. The changes of K after operation and its relationship with the resected tissue volume were analyzed statistically. Results: There was a significant drop in K , from 0.192?.021 before operation to 0.135?.019 on postoperative day 3 (P0.01), and then it remained low on postoperative day 7 (0.144?.025, P0.05). How