The Comprehensive Evaluation of Liver Reserve Funciton for Liver Resection Patients in Perioperative Period
|Course||Department of General Surgery|
|Keywords||indocyanine green retention rate at 15 min(ICGR15) cholinesterase(ChE) liver reserve function hepatectomy hepatic insufficiency liver failure|
Objective:To evaluate the value of multiple factors on evaluation of liver reserve function for liver resection patients in perioperative peroid.Method:Accumulate the patients suffered to hepatectomy from September 2009 to April 2010 in hepatopancreatobiliary surgery department (total 98 cases), with routine hepatic function examination, doppler ultrasound, computerized tomography, prothrombin time, cholinesterase (ChE). indocyanine green retention rate at 15 min (ICGR15) and carry out Child-Pugh grade and score.According to the recover of the postoperative liver function these patients were divided into three groups:restore good (A)、liver compensation mild inadequate (B)、liver compensation severe inadequate (C). Then comprehensive analysis with ChE. Child-pugh score. ICGR15. and other factors. Results:Of ninety-eight patients, eighty-three cases of cancer, the rate of Liver compensation inadequate is 32.9%; 15 cases of benign disease, the ratio is 13.3%.Eighty-three cases of cancer were divided into three groups:Group a ICGR15≤10%、Group b 10%<ICGR15< 15%、Group c ICGR15≥15%, the ratio of the liver compensation inadequate respectively is 18.2%、45.5%、50%,there is significant difference (P=0.045)Eighty-three cases of cancer, the analysis of ICGR15、ChE、Child-pugh score is significant difference between Group A and Group D(P<0.05)，and three indexes have correlation(P<0.001).Sixty-six cases of cancer, pre-operation ICGR15<10%, the ratio of the liver compensation inadequate is 21.2%(11/52) in post-operation ChE<5500 U/L; the ratio is 57.1%(8/14) in post-operation ChE>5500 U/L, There is significant difference (X2=5.324 P=0.021) between two groups. The ratio of the liver compensation inadequate is 12.0%(3/25) in post-operation ChE> 4000 U/L; the ratio is 41.5% (17/41) in post-operation ChE< 4000 U/L.There is significant difference (X2=3.946 P=0.047) between two groups.Conclusions:combining use of ICGR15 and ChE can forecast the liver reserve function after hepatectomy.