Hepatectomy Based on Future Liver Remnant Plasma Clearance Rate of Indocyanine Green.
Hepatectomy Based on Future Liver Remnant Plasma Clearance Rate of Indocyanine Green.
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DOI：
10.1155/2016/7637838
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Yoshimura T
中科院分区：
文献类型：
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作者：
Uchida Y;Furuyama H;Yasukawa D;Nishino H;Ando Y;Hata T;Machimoto T;Yoshimura T
背景资料。肝切除术是肝脏恶性肿瘤的重要治疗手段，具有较高的围手术期发病率和死亡率。选择肝切除患者的安全、全面的标准是必要的。自2011年6月以来，我们一直使用吲哚青绿未来肝脏残留血浆清除率的≧0.05值作为肝切除的标准。本研究的目的是验证这一标准的有效性。方法：研究方法。2011年6月至2015年12月，特尼约罗祖医院共施行212例肝切除手术。在这212例患者中，107例接受了术前CT成像容量测定、吲哚青绿清除试验和肝切除术(不包括部分切除或摘除)的回顾性分析。结果。无一例术后死亡。术后发生肝功能衰竭59例(55.1%)，其中国际肝外科研究组A级43例(40.2%)，B级16例(15.0%)，C级无1例发生。手术并发症超过Clavien-Dindo 3级者23例(21.5%)。吲哚青绿未来较低的肝脏残存血浆清除率是B级病例的良好预测指标(曲线下面积=0.804；95%可信区间0.712-0.895)。结论。吲哚青绿的肝残余血浆清除率是判断肝切除的有效指标。
Background. Hepatectomy, an important treatment modality for liver malignancies, has high perioperative morbidity and mortality rates. Safe, comprehensive criteria for selecting patients for hepatectomy are needed. Since June 2011, we have used a cut-off value of ≧ 0.05 for future liver remnant plasma clearance rate of indocyanine green as a criterion for hepatectomy. The aim of this study was to verify the validity of this criterion. Methods. From June 2011 to December 2015, 212 hepatectomies were performed in Tenri Yorozu Hospital. Of these 212 patients, 107 who underwent preoperative computed tomography imaging volumetry, indocyanine green clearance test, and hepatectomy (excluding partial resection or enucleation) were retrospectively analyzed. Results. There was no postoperative mortality. Posthepatectomy liver failure occurred in 59 patients (55.1%) (International Study Group of Liver Surgery Grade A: 43 cases (40.2%), Grade B: 16 cases (15.0%), and Grade C: no cases). Operative morbidity greater than Clavien-Dindo Grade 3 occurred in 23 patients (21.5%). A low future liver remnant plasma clearance rate of indocyanine green was a good predictor for Grade B cases (area under curve = 0.804; 95% confidence interval, 0.712–0.895). Conclusion. Liver remnant plasma clearance rate of indocyanine green is a valid criterion for hepatectomy.