ICG测定评估肝癌切除手术安全性研究.docVIP

ICG测定评估肝癌切除手术安全性研究 　　[摘要] 目的 探讨结合吲哚菁绿（indocyanine green，ICG）清除实验决策树在评估肝癌切除手术安全性中的实际价值。 方法 选取2013年1月～2015年12月在我院共收治肝癌患者40例，其中肝脏外科手术切除的肝癌患者28例，评估以吲哚氰绿15 min储留率（ICGR-15）为主的决策树评估肝部分切除术的安全性。 结果 本次临床实验严格遵守日本东京大学肝胆胰外科临床治疗研究所提出的吲哚氰绿清除实验决策树原理，本组病例通过术后病理证实为肝癌共28例患者，28名肝癌患者所测ICGR-15等级呈递增趋势，其中Child-Pugh A级测量值为（6.5±1.8）%、B级测量值为（14.8±3.2）%、C级测量值为（23.1±4.1）%，3级测量值相比有明显差异（P0.05）。且合并肝硬化患者的ICGR-15测量值明显高于无肝硬化患者。此外，患者术后并无重大并发症与二次手术，患者手术后未出现肝功能衰竭致死现象，均安全出院。 结论 以吲哚氰绿为基础所建立的肝胆癌患者清除决策树，在患者临床手术后，能辅助临床医生准确评估肝脏部分切除患者的肝功能现状，有效降低肝癌患者的并发症发病率，有效避免患者出现肝功衰竭，值得推广使用。 　　[关键词] 肝细胞肝癌；肝切除；吲哚氰绿清除试验；肝功能衰竭 　　[中图分类号] R735.7 [文献标识码] B [文章编号] 1673-9701（2016）21-0042-04 　　[Abstract] Objective To discuss the application value of decision-making tree with indocyanine green（ICG） cleaning experiment in safety evaluation of liver cancer resection. Methods 40 patients with liver cancer treated in our hospital from January 2013 to December 2015 were selected， of which 28 patients were given surgical resection. The safety of liver cancer resection determined by decision-making tree with 15 min retention rate of ICG（ICGR-15） was evaluated. Results This clinical trial strictly observed the principle of decision-making tree with ICG cleaning experiment raised by Clinical Treatment Institute of Hepatopancreatobiliary Surgery， University of Tokyo， Japan. Among the patients in this study， 28 were confirmed with liver cancer by postoperative pathology. The grades of ICGR-15 of the 28 patients showed an increasing tendency， with the measurement values of Child-Pugh grade A as （6.5±1.8）%， grade B as （14.8±3.2）%， and grade C as（23.1±4.1）%. There were significant differences between the measurement values of the three grades（P0.05）. The values of ICGR-15 in patients combined with liver cirrhosis were significantly higher than those in patients without liver cirrhosis. In addition， there was no significant complication or second operation after surgery. No patient experienced hepatic failure causing death. All patients were sa