Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
HPB (Oxford). 2011 Aug;13(8):559-65. doi: 10.1111/j.1477-2574.2011.00329.x. Epub 2011 Jun 14.
Hepatic resection in patients with chronic liver disease (CLD) is associated with a risk of post-operative liver failure and higher morbidity than patients without liver disease. There is no universal risk stratification scheme for CLD patients undergoing resection.
The aim of the present study was to evaluate the association between routine pre-operative laboratory investigations, model for end-stage liver disease (MELD), indocyanine green retention at 15 min (ICG15) and post-operative outcomes in CLD patients undergoing liver resection.
A retrospective review of patients undergoing resection for hepatocellular carcinoma (HCC) at the University Health Network was preformed. ICG15 results, pre- and post-operative laboratory results were obtained from clinical records. Adjusted odds ratios (AOR) were calculated for associations between pre-operative factors and post-operative outcomes using multivariate logistic regression adjusting for patient age and number of segments resected.
Between 2001 and 2005, 129 CLD patients underwent surgical resection for HCC. Procedures included 51 (40%) resections of ≤ 2 segments, 52 (40%) hemihepatectomies and 25 (19%) extended hepatic resections. Thirty- and 90-day post-operative mortality was 1.6% and 4.1%, respectively. Prolonged (>10 days) hospital length of stay (LOS) was independently associated with an ICG15 >15% {AOR [95% confidence interval (CI)]= 8.5 (1.4-51)} and an international normalized ratio (INR) > 1.2 [AOR (95% CI) = 5.0 (1.4-18.6)]. An ICG15 > 15% and MELD score were independent predictors of prolonged LOS. An ICG15 > 15% was also independently associated with MELD > 20 on post-operative day 3 [AOR (95% CI) = 24.3 (1.8-319)].
Elevated ICG retention was independently associated with post-operative liver dysfunction and morbidity. The utility of ICG in combination with other biochemical measures to predict outcomes after hepatic resection in CLD patients requires further prospective study.
与无肝病患者相比，慢性肝病（CLD）患者行肝切除术与术后肝功能衰竭和更高发病率相关。目前尚无针对行切除术的 CLD 患者的通用风险分层方案。
本研究旨在评估常规术前实验室检查、终末期肝病模型（MELD）、吲哚菁绿 15 分钟滞留率（ICG15）与 CLD 患者肝切除术后结局之间的关系。
对多伦多大学健康网络行肝切除术的 HCC 患者进行回顾性分析。从病历中获取 ICG15 结果、术前和术后实验室结果。使用多变量逻辑回归，在校正患者年龄和切除段数后，计算术前因素与术后结局之间的调整比值比（AOR）。
2001 年至 2005 年间，129 例 CLD 患者因 HCC 行手术切除。手术包括 51 例（40%）≤ 2 个节段切除术、52 例（40%）半肝切除术和 25 例（19%）扩大肝切除术。术后 30 天和 90 天的死亡率分别为 1.6%和 4.1%。住院时间延长（>10 天）与 ICG15>15%（AOR[95%CI]：8.5[1.4-51]）和国际标准化比值（INR）>1.2（AOR[95%CI]：5.0[1.4-18.6]）独立相关。ICG15>15%和 MELD 评分是住院时间延长的独立预测因子。ICG15>15%也与术后第 3 天 MELD>20 独立相关（AOR[95%CI]：24.3[1.8-319]）。
ICG 滞留升高与术后肝功能障碍和发病率独立相关。ICG 与其他生化指标联合用于预测 CLD 患者肝切除术后结局的效用需要进一步的前瞻性研究。
