Perioperative real-time monitoring of indocyanine green clearance by pulse spectrophotometry predicts remnant liver functional reserve in resection of hepatocellular carcinoma
Perioperative real-time monitoring of indocyanine green clearance by pulse spectrophotometry predicts remnant liver functional reserve in resection of hepatocellular carcinoma
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DOI：
10.1002/bjs.5258
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发表时间：
2006-03-01
影响因子：
9.6
通讯作者：
Okabe, T
中科院分区：
文献类型：
--
作者：
Ohwada, S;Kawate, S;Okabe, T
背景资料：目前还没有标准的方法来预测肝切除术后残余肝脏的功能储备或监测它在真实的time.Methods：吲哚菁绿色（ICG）清除率（K）进行了测量非侵入性和即时使用脉冲分光光度法在手术前，在流入阻断和肝切除术后的75例肝细胞癌（HCC）接受解剖肝切除术。8名患者（11%）出现肝功能衰竭，1名（1%）在医院死亡。估计的残余K值为0（.）090/min为肝功能衰竭的临界值。在逻辑回归模型中，估计的残差K（0（.）090/min; P = 0（.）022)和年龄（65岁; P = 0（.）025)是术后肝功能衰竭的重要预测因素。肝切除术后K值的估计值与实测值之间、流入道阻断K值与实测值之间存在相关性（P < 0. 05）。001）。小于0的截止值（.）090每分钟的估计残余K导致88%的敏感性和82%的特异性预测liver failure.Conclusion：围手术期实时监测ICG-K是有用的，用于评估残余肝功能储备之前，期间和之后肝切除肝癌。估计的残余K是肝衰竭的重要预测因子。
Background: There is no standard method for predicting remnant liver functional reserve after hepatectomy or for monitoring it in real time.Methods: Indocyanine green (ICG) clearance (K) was measured non-invasively and instantaneously using pulse spectrophotometry before surgery, during inflow occlusion and after hepatectomy in 75 patients who underwent anatomical liver resection for hepatocellular carcinoma (HCC).Results: Eight patients (11 per cent) suffered liver failure and one (1 per cent) died in hospital. An estimated remnant K value of 0(.)090 per min was the cut-off value for liver failure. In a logistic regression model, the estimated remnant K (0(.)090 per min; P = 0(.)022) and age (65 years; P = 0(.)025) were significant predictors of postoperative liver failure. There was a correlation between the estimated and measured post-hepatectomy K, and between the inflow occlusion K and measured post-hepatectomy K (P < 0(.)001). The cut-off value of less than 0(.)090 per min for the estimated remnant K resulted in 88 per cent sensitivity and 82 per cent specificity for predicting liver failure.Conclusion: Perioperative real-time monitoring of ICG-K is useful for evaluating the remnant liver functional reserve before, during and after liver resection for HCC. The estimated remnant K is a significant predictor of liver failure.