Departments of Surgery, Division of Hepato-Biliary-Pancreas Surgery.
Radiology, Faculty of Medicine, University of Miyazaki, Kihara, Kiyotake, Miyazaki, Japan.
Nucl Med Commun. 2020 Apr;41(4):320-326. doi: 10.1097/MNM.0000000000001162.
The indocyanine green retention rate at 15 min (ICGR15) is a gold standard parameter of liver function when deciding on the extent of hepatectomy. However, ICGR15 is influenced by several hepatic conditions. To evaluate auxiliary preoperative liver functional reserve, we examined the clinical significance of modified parameters by blood tests and technetium-99m galactosyl human serum albumin (Tc-GSA) scintigraphy.
We measured liver function parameters, including the hepatic uptake ratio (LHL15) and the blood pool clearance index (HH15) of Tc-GSA and their modified formulae [LHL/HH15, LHL minus HH15, and converted ICGR15 (cICGR15) from a preliminary study] in 229 patients, including 18 with biliary obstruction.
The mean values of LHL15/HH15, LHL minus HH15, and cICGR15 were 1.646 ± 0.295, 0.347 ± 0.116, and 13.2 ± 5.3%, respectively. These parameters correlated significantly with other liver functions measured by blood tests except for the bilirubin level (P < 0.05) although the actual ICGR15 level correlated positively with the bilirubin level. The difference of ICGR15 (ICGR15 minus cICGR15) in patients with biliary obstruction tended to be higher in comparison with that in patients without biliary obstruction (P = 0.044). Values of LHL/HH15, LHL minus HH15, and the cICGR15 were not significantly associated with postoperative complications.
The modified parameters of Tc-GSA were useful for evaluating hepatic function in patients with high bilirubinemia due to biliary obstruction. However, it remains difficult to establish a more reliable parameter as a standard hepatic function test instead of ICGR15.
当决定肝切除范围时，15 分钟吲哚菁绿潴留率（ICGR15）是肝功能的金标准参数。然而，ICGR15 受多种肝脏状况的影响。为了评估辅助术前肝储备功能，我们通过血液检查和锝-99m 半乳糖基人血清白蛋白（Tc-GSA）闪烁照相术检查了改良参数的临床意义。
我们测量了包括肝脏摄取率（LHL15）和 Tc-GSA 血池清除指数（HH15）在内的肝功能参数，以及其改良公式[LHL/HH15、LHL 减去 HH15 和初步研究中转换的 ICGR15（cICGR15）]，共 229 例患者，包括 18 例有胆道梗阻的患者。
LHL15/HH15、LHL 减去 HH15 和 cICGR15 的平均值分别为 1.646±0.295、0.347±0.116 和 13.2±5.3%。这些参数与血液检查中测量的其他肝功能指标显著相关，除了胆红素水平（P<0.05），尽管实际的 ICGR15 水平与胆红素水平呈正相关。与无胆道梗阻的患者相比，有胆道梗阻的患者的 ICGR15 差值（ICGR15 减去 cICGR15）倾向于更高（P=0.044）。LHL/HH15、LHL 减去 HH15 和 cICGR15 的值与术后并发症无显著相关性。
Tc-GSA 的改良参数对于评估由于胆道梗阻而导致高胆红素血症的患者的肝功能是有用的。然而，要建立一个更可靠的参数来替代 ICGR15 作为肝功能标准检测仍然很困难。
