Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test
Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test
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DOI：
10.1007/s00534-004-0965-9
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发表时间：
2005-02-01
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影响因子：
--
通讯作者：
Makuuchi, Masatoshi
中科院分区：
文献类型：
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作者：
Imamura, Hiroshi;Sano, Keiji;Makuuchi, Masatoshi
术前评估肝功能和预测术后剩余的功能性肝实质质量和储备对于降低手术风险至关重要，特别是在肝细胞癌（HCC）患者中，其中大多数患者合并肝硬化。我们建立了一个决策树，根据三个变量来决定肝切除术的安全限度：是否存在腹水，血清总胆红素水平，以及15分钟时吲哚菁绿色留存率（ICGR-15），一个窦状毛细血管化的指标。对于表现出失代偿性肝硬化体征的患者，如胆红素值升高或无法控制的腹水，则不适用肝切除术。在无腹水且胆红素水平正常的患者中，ICGR-15值成为可切除性和肝切除术的主要决定因素。将ICGR-15纳入决策树使得常规分类为Child-Turcotte-Pugh A级或评分5-6的患者能够被细分为几个组，其中各种肝切除术程序是可行的：剜出术、有限切除术、肝段切除术、单切除术至二切除术和三切除术。在过去的10年中，我们严格应用该决策树对1429例连续肝切除术（其中685例为HCC患者）进行分析，仅发现一例死亡。
Preoperative assessment of liver function and prediction of postoperative remaining functional liver parenchymal mass and reserve is of paramount importance to minimize surgical risk, especially in patients with hepatocellular carcinoma (HCC), the majority of whom have liver cirrhosis as a complication. We have established a decision tree for deciding the safe limit of hepatectomy based on three variables: whether ascites is present, the serum total bilirubin level, and the indocyanine green retention rate at 15 minutes (ICGR-15), an indicator of sinusoidal capillarization. In patients who show a sign of decompensated cirrhosis as reflected by an elevated bilirubin value or uncontrollable ascites, hepatectomy is not indicated. In patients without ascites and with normal bilirubin level, the ICGR-15 value becomes the main determinant for the resectability and hepatectomy procedure. Incorporation of ICGR-15 into the decision tree enables patients conventionally classified into Child-Turcotte-Pugh class A or score 5-6 to be subdivided into several groups in which various hepatectomy procedures are feasible: enucleation, limited resection, segmentectomy, mono- to bisectoriectomy, and trisectriectomy. During strict application of this decision tree to 1429 consecutive hepatectomies, of which 685 were performed on HCC patients, during the last 10 years, we encountered only a single mortality.