ICGR15联合三维评估系统在精准肝切除中的应用

摘要

Objective To investigate the application of indocyanine green retention rate at 15 min (ICGR15) combined with three-dimensional evaluation system in the precise liver resection.Methods Forty-three patients with hepatocarcinoma and cirrhosis undergoing surgery were selected.We imported their preoperative intensive CT results into three dimensional evaluation system, and combined with preoperative ICGR15 and routine examination to develop and assess the surgical plan.According to the compensatory liver function after hepatectomy, we divided them into the liver function recovery group and hypohepatia group. The corresponding indicators of the two groups were analyzed.Results There were no statistically significant differences in age, operation time, preoperative transaminase, bilirubin and liver resection rate between the two groups (P>0.05).Significant differences were found in the preoperative acetylcholinesterase, preoperative and intraoperative ICGR15, bleeding volume and standardized remnant liver volume ratio between the two groups (P<0.05).The ROC area under the curve analysis showed that the cutoff value of intraoperative ICGR15/preoperative ICGR15(R) in predicting postoperative hepatic insufficiency was 1.781, the sensitivity was 85.7%, and the specificity was 86.2%.No statistically significant difference was found in predicting liver re-section volume and actual liver resection volume by using three-dimensional evaluation system (t=0.918, P=0.362), and the two numerical values had good correlation (r=0.989, P<0.05).Conclusion ICGR15 combined with three-dimensional evalua-tion system can better predict the recovery of liver function after liver resection, for patients, their R ( intraoperative/preopera-tive) is greater than 1.781, the risk of postoperative hepatic insufficiency is high;three dimensional evaluation system can help to measure liver volume, and help to make the preoperative surgical plan.%目的：探讨吲哚氰绿15 min滞留率（ICGR15）联合三维评估系统在精准肝切除中的应用价值。方法选取43例肝癌合并肝硬化行手术治疗的患者，将术前强化CT结果导入三维评估系统，联合患者术前ICGR15及常规检查情况，制定并评估手术方案，根据患者肝切除术后肝功能代偿情况分为肝功能恢复组及肝功能不全组，对两组患者相应指标进行比较分析。结果两组年龄、手术时间、术前转氨酶、术前胆红素、肝切除率差异无统计学意义（P＞0．05），而术前乙酰胆碱酯酶、术前ICGR15、术中ICGR15、术中ICGR15／术前ICGR15（R）、残肝体积占标准化全肝体积的比例差异有统计学意义（P＜0．05）。 R预测术后肝功能不全的截断值为1．781，敏感度为85．7％，特异度为86．2％；三维评估系统预测肝切除体积与实际肝切除体积比较差异无统计学意义（t＝0．918，P＝0．362），两者有较好的相关性（r＝0．989，P＜0．05）。结论 ICGR15联合三维评估系统可较好地预测肝切除术后肝功能恢复情况，R大于1．781患者术后出现肝功能不全的可能性较大；三维评估系统可良好协助测量肝脏体积，有助于术前手术方案的制定。