Mei Lixiang, Wang Dong, Li Huanni, Li Zengbo, Zhou Ledu
Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2017 Jun 28;42(6):635-640. doi: 10.11817/j.issn.1672-7347.2017.06.006.
To investigate the value of indocyanine green retention rate at 15 minutes (ICG R15) on postoperative day 3 combined with standard remnant liver volume (SRLV) in predicting the occurrence of liver dysfunction after hepatectomyin hepatocellular carcinoma (HCC). Methods: The clinical data of 61 HCC patients undergone hepatectomy in Xiangya Hospital of Central South University from January 2015 to February 2016 were collected and analyzed. The patients were divided into 2 groups: a normal liver function group (n=40) and a liver dysfunction group (n=21). Univariate analysis was used to evaluate the risk factors for postoperative liver dysfunction. Logistic regression was used to assess the independent risk factors for postoperative liver dysfunction, and the regression equation between independent risk factors and postoperative liver dysfunction was established. The receiver operating characteristic (ROC) curve was used to examine the regression equation and compare the value difference in predicting postoperative liver dysfunction between single and combined independent risk factors. Results: Postoperative liver dysfunction occurred in 21 of the 61 patients, with an incidence rate at 34.4%. There was no significant difference in the time of operation, time of hepatic portal occlusion, volume of tumor and volume of resected liver between the 2 groups (all P>0.05), but there were significant differences in the ICG R15 on postoperative day 3, intraoperative blood loss and SRLV between the 2 groups (all P<0.05). The ICG R15 on postoperative day 3, intraoperative blood loss, SRLV were the risk factors for postoperative liver dysfunction. Logistic regression analysis showed ICG R15 on postoperative day 3 and SRLV were the independent risk factors for postoperative liver dysfunction, and the regression equation between independent risk factors and postoperative liver dysfunction was as follows: logit(P)=1.277+0.140×ICG R15 on postoperative day 3-5.125×SRLV. The area under the ROC curve of ICG R15 on postoperative day 3 combined with SRLV was more than that of single ICG R15 and single SRLV. Conclusion: ICG R15 on postoperative day 3 and SRLV are the independent risk factors for postoperative liver dysfunction. The regression equation, which is established by combination of ICG R15 with SRLV, can predict the occurrence of postoperative liver dysfunction. The accuracy of ICG R15 on postoperative day 3 combined with SRLV is better than that of single ICG R15 or single SRLV.
探讨术后第3天的吲哚菁绿15分钟滞留率（ICG R15）联合标准残余肝体积（SRLV）在预测肝细胞癌（HCC）肝切除术后肝功能障碍发生中的价值。方法：收集并分析2015年1月至2016年2月在中南大学湘雅医院接受肝切除术的61例HCC患者的临床资料。将患者分为2组：肝功能正常组（n = 40）和肝功能障碍组（n = 21）。采用单因素分析评估术后肝功能障碍的危险因素。采用Logistic回归分析评估术后肝功能障碍的独立危险因素，并建立独立危险因素与术后肝功能障碍之间回归方程。采用受试者工作特征（ROC）曲线检验回归方程，并比较单个和联合独立危险因素在预测术后肝功能障碍方面的价值差异。结果：61例患者中21例发生术后肝功能障碍，发生率为34.4%。两组患者手术时间、肝门阻断时间、肿瘤体积及切除肝脏体积比较，差异均无统计学意义（均P>0.05），但两组患者术后第3天的ICG R15、术中出血量及SRLV比较，差异均有统计学意义（均P<0.05）。术后第３天的ICG R15、术中出血量、SRLV是术后肝功能障碍的危险因素。Logistic回归分析显示，术后第3天的ICG R15和SRLV是术后肝功能障碍的独立危险因素，独立危险因素与术后肝功能障碍之间的回归方程为：logit(P)=1.277+0.140×术后第3天的ICG R15-5.125×SRLV。术后第3天的ICG R15联合SRLV的ROC曲线下面积大于单个ICG R15和单个SRLV。结论：术后第3天的ICG R15和SRLV是术后肝功能障碍的独立危险因素。由ICG R15与SRLV联合建立的回归方程可预测术后肝功能障碍的发生。术后第3天的ICG R15联合SRLV的预测准确性优于单个ICG R15或单个SRLV。
