吲哚菁绿排泄试验在门静脉高压症手术患者中的-第三军医大学学报.DOC

吲哚菁绿排泄实验在门静脉高压症择期手术中的临床应用意义 潘龙 杜成友 李德卫 重庆医科大学附属第一医院肝胆外科 通信作者：潘龙中英文通讯作者不一致 重庆市渝中区友谊路1号 400016 panlong1986@126.com 中英文通讯作者不一致 【摘要】目的 探讨吲哚菁绿（ICG）排泄实验对门静脉高压症患者择期外科治疗的指导意义。方法 回顾性分析我科2011.04-2013.05 47例肝硬化门静脉高压症患者行择期联合断流术的临床资料，根据患者术前吲哚菁绿15分钟排泄率（ICGR15）水平将患者分为ICGR1510%（A组），10% ICGR1530%（B组），ICGR1530%（C组）三组。根据患者术后是否发生重度肝功能损害，将患者分为轻度肝功能受损组（M组），重度肝功能损害组（S组）。分析各组患者临床资料的差异。结果 A、B、C三组患者术前Child-Pugh评分相当、术中出血量及手术时间相似(P0.05)，而术后最低白蛋白水平（30.14 ±2.77g/L VS 26.72±4.05 VS 24.00±3.96 g/L,P0.05）、术后最高胆红素水平（21.32±8.57μmol/L VS 30.74±12.30μmol/L VS 33.63±14.600μmol/L, P0.05）、术后肝功能恢复时间（7.86±3.59d VS 13.12±6.55d VS 17.75±8.53d,P0.05）及术后严重肝功能损害发生率（7.1%VS12%VS50%，P0.05）均存在显著差异；M组与S组间仅术前ICGR15水平显著不同（P0.05）。结论 对于择期联合断流术患者，患者术后肝功能不全主要与患者肝脏储备功能相关，而非手术麻醉打击；术前ICGR15较之Child-Pugh评分能更准确的反应患者肝功能储备，能够更准确的预测术后重度肝功能损害；恢复患者肝功能储备亦应是术前保肝治疗的目标之一。 关键词 门静脉高压症; 肝功能储备; 吲哚菁绿 Value of Indocyanine green clearance test in selective surgical treatment of portal hypertension Pan Long, Du Cheng-you, Li De-wei Department of Hepatobiliary Surgery, the First Affiliated Hospital of Chongqing Medical Unive Corresponding author: Du Cheng-you,中英文通讯作者不一致 TEL:023e-mail: duchengyou@126.com 中英文通讯作者不一致 【Abstract】Object To assess the vale of Indocyanine green clearance test in selective surgical treatment of portal hypertension. Method Clinical data of 47 portal hypertension patients who received surgical treatment in the First Affiliated Hospital of Chongqing Medical University from April 2011 to May 2013 was collected. According to Indocyanine green clearance at 15min, these patients were divided into Group A (ICGR1510%), Group B( 10% ICGR1530% ) and Group C (ICGR1530%).And according to postoperative liver dysfunction, they were divided into Team M with mild liver dysfunction and Team S with sever liver dysfunction. Clinical data was compared among these groups. Result Among three groups, Child-Pugh score, blooding amount and operation time were similar; postoperative lowest serum albumin（30.14 ±2.77g/