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目的:探讨结合吲哚菁绿(indocyanine green,ICG)清除试验的决策树评估肝癌肝部分切除术患者肝脏储备功能的临床应用价值。方法:选取2009年2月至2010年7月在南京医科大学第一附属医院肝脏外科手术切除的肝细胞肝癌患者82例,评估腹水并检测吲哚氰绿15 min储留率(ICGR-15)及总胆红素,探讨东京大学肝胆胰外科建立的一个基于上述三个变量的决策树评估肝部分切除术的安全性。结果:本组病例中通过术后病理证实为肝细胞肝癌的82例患者,严格遵照东京大学肝胆胰外科制定的结合吲哚氰绿清除试验的决策树行肝部分切除术后无重大并发症及再次手术,所有患者术后无1例发生肝功能衰竭及手术后死亡,术后均安全出院。结论:结合吲哚氰绿清除试验的决策树能够准确评估肝部分切除患者的肝储备功能状况,对避免患者术后发生肝功能衰竭有重要的临床指导作用。
Objective: To investigate the clinical value of using the decision tree of indocyanine green (ICG) clearance test in assessing the liver function of liver cancer patients undergoing partial hepatectomy. Methods: From February 2009 to July 2010, 82 patients with hepatocellular carcinoma who were surgically removed from the liver in the First Affiliated Hospital of Nanjing Medical University were selected. The ascites was evaluated and the ICGR-15 retention rate was measured. And total bilirubin, to explore the decision-making tree based on the above three variables established by the University of Tokyo hepatobiliary and pancreatic surgery to evaluate the safety of partial hepatectomy. Results: The 82 cases of hepatocellular carcinoma confirmed by postoperative pathology in this group of patients were in strict compliance with the decision tree combined with indocyanine green clearance test developed by the University of Tokyo for Hepatobiliary and Pancreatic Surgery. There were no major complications after partial hepatectomy and After surgery again, none of the patients had liver failure and died after the operation, all were discharged safely after operation. Conclusion: The decision tree with indocyanine green clearance assay can accurately assess the hepatic reserve status of patients undergoing partial hepatectomy and has an important clinical guiding role in preventing postoperative liver failure.