Ariizumi Shun-ichi, Yamamoto Masakazu, Takasaki Ken
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Dig Surg. 2009;26(2):135-42. doi: 10.1159/000206151. Epub 2009 Mar 5.
BACKGROUND/AIMS: Liver failure after right hepatectomy for hepatocellular carcinoma (HCC) in patients with an indocyanine green retention rate at 15 min (ICGR(15)) of 10% or higher remains a controversial issue.
Between 1995 and 2004, 98 patients with an ICGR(15) of 10% or higher were scheduled to undergo right hepatectomy or tri-sectionectomy for HCC. The hepatic resection volume (HR) excluding the tumor was measured using computed tomography. The allowable HR (AHR) was determined in each patient with a logarithmic graph based on the ICGR(15) and the %HR. Liver failure and mortality were evaluated between 54 patients with HR <or= AHR (low-risk group) and 44 patients with HR > AHR (high-risk group).
The number of patients with liver failure was significantly lower in the low-risk group (2%) than in the high-risk group (23%, p = 0.0021). No mortality was observed in the low-risk group, while mortality was seen in the high-risk group (11%, p = 0.016). Multivariate analysis showed that the high-risk group was identified as a significant predictor of liver failure (p = 0.011).
In patients with an ICGR(15) of 10% or higher, determination of AHR is useful to predict liver failure prior to right hepatectomy or tri-sectionectomy.
背景/目的：对于吲哚菁绿15分钟潴留率（ICGR(15)）为10%或更高的肝细胞癌（HCC）患者，右肝切除术后发生肝衰竭仍是一个有争议的问题。
1995年至2004年期间，98例ICGR(15)为10%或更高的患者计划接受HCC的右肝切除术或三段切除术。使用计算机断层扫描测量不包括肿瘤的肝切除体积（HR）。根据ICGR(15)和HR百分比，通过对数图确定每位患者的允许肝切除体积（AHR）。对54例HR≤AHR的患者（低风险组）和44例HR＞AHR的患者（高风险组）的肝衰竭和死亡率进行评估。
低风险组肝衰竭患者数量（2%）显著低于高风险组（23%，p = 0.0021）。低风险组未观察到死亡，而高风险组有死亡病例（11%，p = 0.016）。多因素分析显示，高风险组被确定为肝衰竭的显著预测因素（p = 0.011）。
对于ICGR(15)为10%或更高的患者，确定AHR有助于在右肝切除术或三段切除术之前预测肝衰竭。
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