• 四川大學(xué)華西醫(yī)院肝臟及周圍血管外科(成都610041);

目的 探討脈搏染料光密度法吲哚氰綠(PDD-ICG)排泄試驗(yàn)評估肝儲備功能的價(jià)值。
方法 對我院2007年3月至2008年2月間收治的75例因肝癌行肝切除術(shù)的患者行前瞻性研究,根據(jù)術(shù)后肝功能代償情況分組,比較不同組間術(shù)前檢查指標(biāo)的差異; 并根據(jù)ICG清除率(K)值和ICG15 min儲留率(R15)值再分別分組,比較各組間術(shù)后肝功能中重度功能障礙發(fā)生率的差異。
結(jié)果 術(shù)后肝功能輕度功能障礙組60例,中度功能障礙組12例,重度功能障礙組3例(因重度功能障礙組例數(shù)過少,納入中度功能障礙組行統(tǒng)計(jì)分析)。輕度功能障礙組與中重度功能障礙組患者的年齡、術(shù)前Child-Pugh評分、PT及INR的差異均無統(tǒng)計(jì)學(xué)意義(P>0.05); 2組間K值和R15值差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。將K值以0.158/min為界分為2組, K<0.158/min組術(shù)后肝功能中重度功能障礙發(fā)生率為47.1%; K≥0.158/min組為12.1%,2組間差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。將R15值以10%為界分為2組, R15≤10%組術(shù)后肝功能中重度功能障礙發(fā)生率為15.9%; R15>10%組為41.7%,2組間差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。
結(jié)論 PDD-ICG試驗(yàn)評估肝切除術(shù)患者肝儲備功能有效、簡便,對預(yù)測患者術(shù)后發(fā)生肝功能損害的程度及避免患者術(shù)后發(fā)生肝功能衰竭有重要的臨床指導(dǎo)作用。

引用本文: 杜正貴,李波,馮曦,尹杰,嚴(yán)律南,文天夫,曾勇. 脈搏染料光密度法吲哚氰綠排泄試驗(yàn)對評價(jià)肝癌切除術(shù)后肝功能不全的價(jià)值. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(2): 133-136. doi: 復(fù)制

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1. 丁佑銘, 張愛民, 劉吉奎, 等. ICG R15和OGTT預(yù)測肝癌患者肝臟儲備功能的價(jià)值 [J]. 中國普通外科雜志, 2001; 10(2): 162.
2. Lau H,Man K,Fan ST,et al. Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy[J].Br J Surg,1997; 84(9): 1255.
3. Hemming AW,Scudamore CH,Shackleton CR,et al. Indocyanine green clearance as a predictor of successful hepatic resection in cirrhotic patients [J]. Am J Surg,1992; 163(5): 515.
4. 楊建國, 李奇志.門靜脈高壓癥患者術(shù)前肝功能儲備的相關(guān)因素分析[J].中國普外基礎(chǔ)與臨床雜志, 2005; 12(6): 616.
5. Poon RT,Fan ST.Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome [J].Liver Transpl,2004; 10(2 Suppl 1): S39.
6. Iijima T,Aoyagi T,Iwao Y,et al.Cardiac output and circulating blood volume analysis by pulse dye-densitometry [J].J Clin Monit,1997; 13(2): 81.
7. Van Thiel DH,Wright HI, Fagiuoli S,et al. Preoperative evaluation of a patient for hepatic surgery[J]. J Surg Oncol Suppl, 1993; 53(S3): 49.
8. 潘華鋒, 陳孝平, 鄒明麗, 等. CT檢查預(yù)測肝癌手術(shù)切除安全性的價(jià)值[J]. 肝膽外科雜志, 2000; 8(3):185.
9. Sakka SG, Koeck H,Meier-Hellmann A.Measurement of indocyanine green plasma disappearance rate by two different dosages [J]. Intensive Care Med,2004; 30(3): 506.
10. Hunton DB,Bollman JL,Hoffman HN.Studies of hepatic function with indocyanine green [J].Gastroenterology,1960; 39: 713.
11. Faybik P,Hetz H.Plasma disappearance rate of indocyanine green in liver dysfunction [J]. Transplant Proc,2006; 38(3): 801.
12. Sakka SG,Reinhart K,Meier-Hellmann A.Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients [J].Chest,2002;122(5): 1715.
13. Watanabe Y,Kumon K.Assessment by pulse dye-densitometry indocyanine green(ICG)clearance test of hepatic function of patients before cardiac surgery:its value as a predictor of serious postoperative liver dysfunction [J].J Cardiothorac Vasc Anesth,1999;13(3): 299.
14. Hanazaki K,Matsushita A,Nakagawa K,et al.Risk factors of long-term survival and recurrence after curative resection of hepatocellular carcinoma [J].Hepatogastroenterology,2005; 52(62): 552.
15. 黃冰, 張運(yùn)龍. 循環(huán)血量的床邊無創(chuàng)監(jiān)測-脈搏染料密度分光光度測定法[J].國外醫(yī)學(xué)·麻醉學(xué)與復(fù)蘇分冊, 2000; 21(4): 208.
16. Clemmesen JO,Tygstrup N,Ott P.Hepatic plasma flow estimated according to Fick’s principle in patients with hepatic encephalopathy:evaluation of indocyanine green and D-sorbitol as test substances [J].Hepatology,1998;27(3): 666.
17. Kawasaki S,Sugiyama Y,Iga T,et al.Pharmacokinetic study on the hepatic uptake of indocyanine green in cirrhotic patients [J].Am J Gastroenterol,1985;80(10): 801.
18. Moody FG,Rikkers LF,Aldrete JS.Estimation of the functional reserve of human liver [J].Ann Surg,1974; 180(4): 592.
19. Nonami T,Nakao A,Kurokawa T,et al.Blood loss and ICG clearance as best prognostic markers of post-hepatectomy liver failure [J].Hepatogastroenterology,1999;46(27): 1669.
20. Ishikawa M,Yogita S,Miyake H,et al.Clarification of risk factors for hepatectomy in patients with hepatocellular carcinoma [J].Hepatogastroenterology,2002;49(48): 1625.
21. 淮明生, 戴朝六, 朱興, 等.肝癌患者術(shù)前ICG R15水平與術(shù)后并發(fā)癥的相關(guān)分析 [J].肝膽外科雜志, 2002; 10(1): 31.
22. ImaiT,Takahashi K,Goto F,et al.Measurement of blood concentration of indocyanine green by pulse dye densitometry comparison with the conventional spectrophotometric method [J].J Clin Monit Comput,1998;14(7-8): 477.
23. Hsieh CB,Chen CJ,Chen TW,et al.Accuracy of indocyanine green pulse spectrophotometry clearance test of liver function prediction in transplanted patients [J]. World J Gastroenterol,2004;10(16): 2394.
24. 勞向明, 張亞奇, 關(guān)遠(yuǎn)祥, 等.肝癌術(shù)前ICG R15測定對肝臟儲備功能的評估 [J].癌癥, 2004; 23(10): 1213.
  1. 1. 丁佑銘, 張愛民, 劉吉奎, 等. ICG R15和OGTT預(yù)測肝癌患者肝臟儲備功能的價(jià)值 [J]. 中國普通外科雜志, 2001; 10(2): 162.
  2. 2. Lau H,Man K,Fan ST,et al. Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy[J].Br J Surg,1997; 84(9): 1255.
  3. 3. Hemming AW,Scudamore CH,Shackleton CR,et al. Indocyanine green clearance as a predictor of successful hepatic resection in cirrhotic patients [J]. Am J Surg,1992; 163(5): 515.
  4. 4. 楊建國, 李奇志.門靜脈高壓癥患者術(shù)前肝功能儲備的相關(guān)因素分析[J].中國普外基礎(chǔ)與臨床雜志, 2005; 12(6): 616.
  5. 5. Poon RT,Fan ST.Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome [J].Liver Transpl,2004; 10(2 Suppl 1): S39.
  6. 6. Iijima T,Aoyagi T,Iwao Y,et al.Cardiac output and circulating blood volume analysis by pulse dye-densitometry [J].J Clin Monit,1997; 13(2): 81.
  7. 7. Van Thiel DH,Wright HI, Fagiuoli S,et al. Preoperative evaluation of a patient for hepatic surgery[J]. J Surg Oncol Suppl, 1993; 53(S3): 49.
  8. 8. 潘華鋒, 陳孝平, 鄒明麗, 等. CT檢查預(yù)測肝癌手術(shù)切除安全性的價(jià)值[J]. 肝膽外科雜志, 2000; 8(3):185.
  9. 9. Sakka SG, Koeck H,Meier-Hellmann A.Measurement of indocyanine green plasma disappearance rate by two different dosages [J]. Intensive Care Med,2004; 30(3): 506.
  10. 10. Hunton DB,Bollman JL,Hoffman HN.Studies of hepatic function with indocyanine green [J].Gastroenterology,1960; 39: 713.
  11. 11. Faybik P,Hetz H.Plasma disappearance rate of indocyanine green in liver dysfunction [J]. Transplant Proc,2006; 38(3): 801.
  12. 12. Sakka SG,Reinhart K,Meier-Hellmann A.Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients [J].Chest,2002;122(5): 1715.
  13. 13. Watanabe Y,Kumon K.Assessment by pulse dye-densitometry indocyanine green(ICG)clearance test of hepatic function of patients before cardiac surgery:its value as a predictor of serious postoperative liver dysfunction [J].J Cardiothorac Vasc Anesth,1999;13(3): 299.
  14. 14. Hanazaki K,Matsushita A,Nakagawa K,et al.Risk factors of long-term survival and recurrence after curative resection of hepatocellular carcinoma [J].Hepatogastroenterology,2005; 52(62): 552.
  15. 15. 黃冰, 張運(yùn)龍. 循環(huán)血量的床邊無創(chuàng)監(jiān)測-脈搏染料密度分光光度測定法[J].國外醫(yī)學(xué)·麻醉學(xué)與復(fù)蘇分冊, 2000; 21(4): 208.
  16. 16. Clemmesen JO,Tygstrup N,Ott P.Hepatic plasma flow estimated according to Fick’s principle in patients with hepatic encephalopathy:evaluation of indocyanine green and D-sorbitol as test substances [J].Hepatology,1998;27(3): 666.
  17. 17. Kawasaki S,Sugiyama Y,Iga T,et al.Pharmacokinetic study on the hepatic uptake of indocyanine green in cirrhotic patients [J].Am J Gastroenterol,1985;80(10): 801.
  18. 18. Moody FG,Rikkers LF,Aldrete JS.Estimation of the functional reserve of human liver [J].Ann Surg,1974; 180(4): 592.
  19. 19. Nonami T,Nakao A,Kurokawa T,et al.Blood loss and ICG clearance as best prognostic markers of post-hepatectomy liver failure [J].Hepatogastroenterology,1999;46(27): 1669.
  20. 20. Ishikawa M,Yogita S,Miyake H,et al.Clarification of risk factors for hepatectomy in patients with hepatocellular carcinoma [J].Hepatogastroenterology,2002;49(48): 1625.
  21. 21. 淮明生, 戴朝六, 朱興, 等.肝癌患者術(shù)前ICG R15水平與術(shù)后并發(fā)癥的相關(guān)分析 [J].肝膽外科雜志, 2002; 10(1): 31.
  22. 22. ImaiT,Takahashi K,Goto F,et al.Measurement of blood concentration of indocyanine green by pulse dye densitometry comparison with the conventional spectrophotometric method [J].J Clin Monit Comput,1998;14(7-8): 477.
  23. 23. Hsieh CB,Chen CJ,Chen TW,et al.Accuracy of indocyanine green pulse spectrophotometry clearance test of liver function prediction in transplanted patients [J]. World J Gastroenterol,2004;10(16): 2394.
  24. 24. 勞向明, 張亞奇, 關(guān)遠(yuǎn)祥, 等.肝癌術(shù)前ICG R15測定對肝臟儲備功能的評估 [J].癌癥, 2004; 23(10): 1213.