吲哚菁绿排泄实验在门静脉高压症择期手术中的意义

Value of indocyanine green clearance test in selective surgical treatment of portal hypertension

摘要:

目的：探讨吲哚菁绿（indocyanine green，ICG）排泄实验对门静脉高压症患者择期外科治疗的指导意义。方法：分析 47例肝硬化门静脉高压症患者行择期联合断流术的临床资料，根据患者术前ICG 15 min排泄率（indocyanine green clearance rate at 15 minute，ICGR15）水平将患者分为ICGR15≤10%（A组），10%< ICGR15≥30%（B组），ICGR15>30%（C组）3组。根据患者术后是否发生重度肝功能损害，将患者分为轻度肝功能受损组（M组），重度肝功能损害组（S组）。分析各组患者临床资料的差异。结果：A、B、C 3组患者术前Child-Pugh评分相当、术中出血量及手术时间相似，以上各组P >0.05；而术后最低血清白蛋白（al－bumin，ALB）水平（P=0.002）、术后最高总胆红素（total bilirubin，TBIL）水平（P=0.012）、术后肝功能恢复时间（P=0.002）及术后严重肝功能损害发生率（P=0.023）均存在统计学差异；M组与S组间仅术前ICGR15水平明显不同（P=0.027）。结论：对于择期联合断流术患者，患者术后肝功能不全主要与患者肝脏储备功能相关，而非手术麻醉打击；术前ICGR15较之Child-Pugh评分能更准确的反应患者肝功能储备，能够更准确的预测术后重度肝功能损害；恢复患者肝功能储备亦应是术前保肝治疗的目标之一。

Abstract:

Objective：To assess the value of indocyanine green clearance test in selective surgical treatment of portal hypertension. Methods：Clinical data of 47 portal hypertension patients who received surgical treatment in the First Affiliated Hospital of Chongqing Medical University from April 2011 to May 2013 were collected. According to indocyanine green clearance at 15 min（ICGR15），these patients were divided into group A（ICGR15<10%），group B（10%≤ICGR15<30%） and group C（ICGR15≥30%）. According to postoperative liver dysfunction，they were divided into team M with mild liver dysfunction and team S with sever liver dysfunction. Clinical data were compared among these groups. Results：Among groups A，B，C，Child-Pugh score，blooding amount and operation time were similar（P >0.05）；the lowest the postoperative serum albumin（P=0.002），the highest the postoperative serum bilirubin（P=0.012）；the postoperative recovery time of liver function（P=0.002） and rate of postoperative severe liver dysfunction（P=0.023） were significantly different among groups. Between team M and team S，preoperative ICGR15 was the only variant parameter（P=0.027）. Conclusion：For selective surgical treatment of portal hypertension，postoperative liver function mainly depends on functional liver re－serve，not surgical procedure. Indocyanine green clearance test is useful for accurate assessment of liver function and it could be a predic－tor of severe liver dysfunction. Recovery of functional liver reserve should be one of the goals preoperative treatment.