ICG清除试验正常肝切除患者术后肝功能影响因素分析.docVIP

ICG清除试验正常肝切除患者术后肝功能影响因素分析 　　摘要：目的 探讨ICG清除试验正常的患者影响肝切除术后肝功能的围手术期因素。方法 回顾性分析2014年1月～2015年12月在我们医院行手术治疗的肝癌患者77例围手术期的临床资料。根据术后肝功能恢复情况分为两组：轻度肝功能不全组（n=55）和中重度肝功能代偿不全组（n=22）。进行组间比较，寻找影响术后肝功能的危险因素。结果 在轻度肝功能不全组和中重度肝功能代偿不全组之间，患者年龄、性别、体重、体重指数、术前转氨酶、白蛋白、INR、胆红素、ICGK、ICGR-15、肿瘤体积、切除肝脏体积无显著性差异；术中出血量、手术时间、标准残肝体积有显著差异。进行多因素回归分析，发现术中出血量、术后标准残肝体积为术后中重度肝功能代偿不全的独立影响因素。结论 术前肝脏储备肝功能正常的患者，需要注意减少术中出血、缩短手术时间、保留足够残肝体积以减少术后肝功能损害、衰竭的发生。 　　关键词：肝切除；肝功能储备；标准残肝体积；吲哚箐绿清除试验15 min滞留率 　　中图分类号：R735.7 文献标识码：A 文章编号：1006-1959（2017）18-0045-03 　　Abstract：Objective To investigate the perioperative factors of liver function after liver resection in patients with normal ICG clearance test.Methods Retrospective analysis of January 2014～December 2015，in our hospital for surgical treatment of 77 patients with liver cancer perioperative clinical data.According to the liver function recovery after surgery were divided into two groups：mild hepatic dysfunction group（n=55）and moderate to severe hepatic dysfunction group（n=22）.Comparison between groups，to find the influence of risk factors of postoperative liver function.Results In patients with mild hepatic insufficiency and moderate to severe liver dysfunction，the age，sex，body weight，body mass index，preoperative transaminase，albumin，INR， bilirubin，ICGK，ICGR-15，tumor volume，there was no significant difference in resection of liver volume；intraoperative blood loss，operation time， standard residual liver volume were significantly different.Multivariate regression analysis showed that intraoperative blood loss， postoperative standard residual liver volume for postoperative moderate to severe liver function compensatory insufficiency of independent factors.Conclusion Preoperative liver reserve in patients with normal liver function，need to pay attention to reduce intraoperative bleeding，shorten the operation time，to retain enough liver volume to reduce postoperative liver damage，failure occurred. 　　Key words：Liver resection；Liver function reserve；Standard residual l