肝癌术后肝功能储备的实验室评价

周伟; 蔡昀; 李悦国; 张鹏

doi:10.3969/j.issn.1000-8179.2012.24.027

肝癌术后肝功能储备的实验室评价

Laboratory Evaluation of Hepatic Reserve after Hepatectomy

摘要

摘要:
目的研究原发性肝癌患者肝切除术后影响肝功能储备的因素。
方法对2011年1月至12月在天津医科大学附属肿瘤医院肝胆科行手术切除的272例的肝细胞肝癌患者资料进行回顾性分析，探讨影响术后肝功能储备的重要因素以及在预后判断中的应用价值。
结果术前高γ-GT是肝功能代偿不全的独立危险因素，ROC曲线显示术前γ-GT预测术后肝功能代偿不全的临界值是168 U/L（灵敏度75.0%，特异度84.1%）。当γ-GT≥168 U/L时，肝功能代偿不全的发生率为37.5%。
结论吲哚氰绿（indocyanine green，ICG）15 min清除率在0~15%范围内的肝癌患者中，术前γ-GT < 168 U/L时，术后肝功能恢复良好。因此，术前监测γ-GT水平并结合ICG 15min清除率可以综合评估患者的肝功代偿能力。

Abstract:
Objective This study aims to study the factors affecting the hepatic reserve in patients with hepatocellular carcinoma after hepatectomy.
Methods We reviewed 272 patients who underwent partial hepatectomy for hepatocellular carcinoma at the Tianjin Medical University Cancer Institute and Hospital between 1 January 2011 and 31 December 2011 to study the factors of post-hepatectomy hepatic reserve and prognosis.
Results Logistic multivariate analysis showed that high gamma-glutamyltransferase (γ-GT) was the independent risk factor of post-hepatectomy hepatic decompensation. Receiver operating characteristics curve analysis showed that the cut-off of preoperative γ-GT predicting post-hepatectomy hepatic decompensation was 168 U/L (sensitivity: 75.0%, specificity: 84.1%). The incidence of post-hepatectomy hepatic decompensation was 37.5% at γ-GT≥168 U/L.
Conclusion Patients whose ICG clearance rate at 15 min ranges from 0% to 15% will recover better at preoperative γ-GT < 168 U/L. Therefore, preoperative monitoring of the γ-GT level and ICG clearance rate at 15 minute are useful for synergistically evaluating the liver functional compensation.

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