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目的:探讨术后第3天吲哚菁绿15 min潴留率(ICG-R15)预测肝细胞肝癌术后肝功能不全发生的价值。方法:回顾2015年1月—2016年2月期间行肝切除的119例肝细胞肝癌患者资料,分析患者术后肝功能不全的发生与术前及术后第3天ICG-R15的关系,并比较术前与术后ICG-R15在预测术后肝功能不全发生的差异。结果:119例患者中共有33例(27.7%)术后发生肝功能不全。发生与未发生肝功能不全患者术前ICG-R15平均值分别为9.7%、5.2%,术后第3天ICG-R15平均值分别为11.8%、5.3%,术前与术后ICG-R15在发生与未发生肝功能不全患者间差异均有统计学意义(均P<0.05)。分层分析显示,术后肝功能不全的发生率均随术前或术后第3天的ICG-R15增加而升高,且均在ICG-R15<10%与>20%的患者间有明显统计学差异(均P<0.05)。术后第3天ICG-R15预测术后肝功能不全发生的ROC曲线下面积较术前ICG-R15大,前者的临界值为7.75(灵敏度为66.7%,特异度为83.7%),后者为3.35(灵敏度为84.8%,特异度为46.5%)。结论:术后第3天ICG-R15与术前ICG-R15一样可预测肝细胞肝癌术后肝功能不全的发生,且可能优于术前ICG-R15。
Objective: To investigate the value of retention of indocyanine green 15 min (ICG-R15) on the third day after operation for the prediction of hepatic dysfunction after hepatocellular carcinoma. Methods: The data of 119 patients with hepatocellular carcinoma who underwent hepatectomy between January 2015 and February 2016 were retrospectively analyzed. The incidence of postoperative hepatic dysfunction was analyzed before and after ICG-R15 on day 3 The difference between preoperative and postoperative ICG-R15 in predicting postoperative liver dysfunction was compared. Results: Of the 119 patients, 33 (27.7%) had liver dysfunction after surgery. The average preoperative ICG-R15 in patients with and without hepatic dysfunction was 9.7% and 5.2%, respectively. The mean ICG-R15 on postoperative day 3 was 11.8% and 5.3%, respectively. ICG-R15 in preoperative and postoperative There were significant differences between patients with and without liver dysfunction (all P <0.05). Hierarchical analysis showed that the incidence of postoperative liver dysfunction were increased with the increase of ICG-R15 on the 3rd day after surgery or postoperatively, and were significantly higher in patients with ICG-R15 <10% and> 20% Statistical difference (all P <0.05). On the third day after operation, the area under the ROC curve of ICG-R15 in predicting postoperative hepatic dysfunction was larger than preoperative ICG-R15. The former had a critical value of 7.75 (sensitivity of 66.7% and specificity of 83.7%), while the latter was 3.35 (sensitivity 84.8%, specificity 46.5%). CONCLUSION: ICG-R15 can be used to predict the incidence of postoperative liver dysfunction in hepatocellular carcinoma on the third day after ICG-R15, which may be superior to preoperative ICG-R15.