Sato Takafumi, Arita Junichi, Inoue Yosuke, Koga Rintaro, Takahashi Yu, Saiura Akio
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research.
Hepato-Biliary-Pancreatic Division, Department of Surgery, The University of Tokyo.
Biosci Trends. 2017 Jul 24;11(3):333-339. doi: 10.5582/bst.2017.01014. Epub 2017 May 8.
Preoperative evaluation of liver functional reserve is important in hepatobiliary surgery. Although the indocyanine green retention rate at 15 minutes (ICG-R15) is the gold standard for this purpose, a new method without technical complexity would be preferable. We assessed the usefulness of the previously established index of convexity (IOC). In total, 159 consecutive patients who underwent both technetium-99m-galactosyl human serum albumin (Tc-GSA) scintigraphy and the ICG-R15 were included. Correlation coefficients between indices from Tc-GSA scintigraphy and blood examinations including ICG-R15 were evaluated, and a conversion formula from the IOC to the ICG-R15 was established. The IOC was calculated as [L(15) × 2 - L(3) - L(27)] / [L(27) - L(3)], where L(t) indicates the radiation counts within the whole liver at t minutes after Tc-GSA injection. The IOC showed a significantly stronger correlation with the ICG-R15 (r = -0.532, p < 0.001) than the index of blood clearance (HH15) and the receptor index (LHL15). A formula for estimating ICG-R15 from IOC was "ICG-R15 = -31.0 × IOC + 30.1". In conclusion, the IOC is a better index for evaluating preoperative liver functional reserve than the conventional indices. A formula for estimating ICG-R15 from the IOC will be useful.
肝脏功能储备的术前评估在肝胆外科手术中至关重要。尽管15分钟吲哚菁绿滞留率（ICG-R15）是用于此目的的金标准，但一种无技术复杂性的新方法会更可取。我们评估了先前建立的凸度指数（IOC）的实用性。总共纳入了159例连续接受过锝-99m-半乳糖基人血清白蛋白（Tc-GSA）闪烁扫描和ICG-R15检测的患者。评估了Tc-GSA闪烁扫描指标与包括ICG-R15在内的血液检查指标之间的相关系数，并建立了从IOC到ICG-R15的换算公式。IOC的计算方法为[L(15)×2 - L(3) - L(27)] / [L(27) - L(3)]，其中L(t)表示注射Tc-GSA后t分钟时全肝内的放射性计数。与血液清除指数（HH15）和受体指数（LHL15）相比，IOC与ICG-R15的相关性显著更强（r = -0.532，p < 0.001）。从IOC估算ICG-R15的公式为“ICG-R15 = -31.0×IOC + 30.1”。总之，与传统指标相比，IOC是评估术前肝脏功能储备的更好指标。从IOC估算ICG-R15的公式将很有用。
