Predictive Value of Intraoperative Indocyanine Green Clearance Measurement on Postoperative Liver Function After Anatomic Major Liver Resection
Predictive Value of Intraoperative Indocyanine Green Clearance Measurement on Postoperative Liver Function After Anatomic Major Liver Resection
复制标题
术中吲哚菁绿清除率测量对解剖性大肝切除术后肝功能的预测价值
DOI：
10.1007/s11605-019-04262-5
复制
发表时间：
2020-06-01
影响因子：
3.2
通讯作者：
Zhao, Yiming
中科院分区：
文献类型：
--
作者：
Wang, Longrong;Xie, Li;Zhao, Yiming
背景本研究的目的是评估术中部分阻断肝叶切除时吲哚菁绿色（ICG）清除率对主要解剖性肝切除术后肝功能的预测价值。方法前瞻性纳入46例患者，其中35例最终行解剖性大肝切除术。术前和术中测量ICG清除率。术中ICG清除率在选择性阻断肝动脉、门静脉和肝静脉血流至待切除肝叶后立即测量。术前测定白蛋白胆红素（ALBI）分级、白蛋白吲哚菁绿色评价（ALICE）分级、血小板计数、每公斤体重残肝体积（RLV/kg）和ICG未来残肝血浆清除率（ICGK FLR）。结果术中ICG 15 min滞留（I-R15）大于13.8%提示肝切除术后一过性肝功能衰竭（PHLF）和Clavien-Dindo > I级并发症。受试者工作特征（ROC）曲线分析显示，预测PHLF和Clavien-Dindo > I级并发症的曲线下面积（AUC）分别为0.797和0.734（p = 0.001和0.014）。此外，I-R15大于22.7%表明中期PHLF，AUC为0.911（p < 0.0001）。与ALBI分级、ALICE分级、血小板计数、RLV/kg和ICGK-FLR相比，I-R15是PHLF的更好预测因子。结论术中ICG清除率测定可准确预测术后肝功能，可作为判断解剖性肝大部切除术可行性和安全性的新指标。
Background The aim of this study was to evaluate the predictive value of measuring indocyanine green (ICG) clearance during intraoperative partial occlusion of liver lobes to be resected on postoperative liver function following major anatomic liver resection. Methods We prospectively included 46 patients, and 35 patients ultimately underwent anatomic major liver resection. ICG clearance was measured preoperatively and intraoperatively. Intraoperative ICG clearance was measured immediately after selective occlusion of hepatic arterial, portal, and hepatic venous blood flow to the liver lobes to be resected. The albumin-bilirubin (ALBI) grade, albumin-indocyanine green evaluation (ALICE) grade, platelet count, remnant liver volume per kilogram of weight (RLV/kg), and future liver remnant plasma clearance rate of ICG (ICGK-FLR) were measured preoperatively. Results An intraoperative ICG retention at 15 min (I-R15) greater than 13.8% indicates transient posthepatectomy liver failure (PHLF) and Clavien-Dindo > grade I complications. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) for predicting PHLF and Clavien-Dindo > grade I complications was 0.797 and 0.734, respectively (p = 0.001 and 0.014). Furthermore, an I-R15 greater than 22.7% indicates mid-term PHLF, and the AUC was 0.911 (p < 0.0001). The I-R15 is a better predictor of PHLF than the ALBI grade, ALICE grade, platelet count, RLV/kg, and ICGK-FLR. Conclusions Intraoperative ICG clearance measurements during partial occlusion of blood flow accurately predict postoperative liver function and could be new criteria for determining the feasibility and safety of anatomic major liver resection.