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背景与目的:肝癌术前正确评估肝脏储备功能、术中合理掌握切肝量是避免肝功能衰竭的重要措施。近年来,吲哚靛青绿储留率(indocyaninegreenretentionrateat15min,ICGR15)已被认为是反映肝脏储备功能的灵敏指标。如何根据肝脏储备功能特别是ICGR15来决定所能切除的最大肝脏体积,目前未有定论。本研究旨在探讨术前ICGR15与术中切除肝体积对术后肝功能不全的影响。方法:对225例手术切除的肝细胞肝癌患者进行研究。观察指标包括术前ICGR15的测定,术中切除的肝段数以及术后患者出现肝功能不全的情况。结果:ICGR15<10%时,切除A组(切除肝段数相当于一个肝段以内)、B组(切除肝段数大于一个肝段,但在两个肝段以内)、C组(切除肝段数大于两个肝段)肝段的腹水产生率分别为21.2%、14.3%、15.4%(P>0.05);黄疸率分别为3.0%、7.1%、15.4%(P>0.05)。ICGR15介于10%～20%时,腹水产生率分别为26.8%、38.9%、50.0%(P>0.05);黄疸率分别为0、27.8%、20.0%,(P<0.01);其中2例死亡,均切除两个或以上肝段。ICGR15>20%时,6例切除A组肝段的患者中有2人出现腹水;而仅有2例切除B组肝段的患者均出现腹水和黄疸,其中1例死亡。结论:可根据ICGR15值粗略决定肝脏切除量。ICGR15<10%时,可切除两个或更多的肝段;ICGR15介于10%～20%时,切除一个肝
BACKGROUND & OBJECTIVE: To correctly assess the function of liver reserve in preoperative liver cancer, it is an important measure to avoid hepatic failure by reasonably grasping the amount of hepatectomy during operation. In recent years, indocyanine green potential retention at15min (ICGR15) has been considered as a sensitive indicator of liver reserve function. How to determine the maximum liver volume that can be resected according to the liver reserve function, especially ICGR15, is not yet concluded. This study aimed to investigate the effect of preoperative ICGR15 and intraoperative resection of liver volume on postoperative liver dysfunction. Methods: 225 resected hepatocellular carcinoma patients were studied. Observations include the determination of preoperative ICGR15, the number of resected liver segments and postoperative patients with liver dysfunction. Results: When ICGR15 was less than 10%, resection was performed in group A (the number of resected liver segments was equal to one liver segment), group B (number of resected liver segments was larger than one liver segment but within two liver segments), group C The incidence of ascites in the liver segment was 21.2%, 14.3% and 15.4% respectively (P> 0.05). The rates of jaundice were 3.0%, 7.1% and 15.4% (P> 0.05). The rates of ascites were 26.8%, 38.9% and 50.0% (P> 0.05) when the ICGR15 ranged from 10% to 20%, and the rates of jaundice were 0, 27.8% and 20.0%, respectively Died, were removed two or more liver segments. In ICGR15> 20%, ascites was found in 2 of 6 patients who underwent resection of the liver segment of Group A; ascitic fluid and jaundice occurred in only 2 of the patients who underwent resection of the liver in Group B, and 1 died. Conclusion: The amount of liver resection can be roughly determined according to ICGR15 values. When ICGR15 <10%, two or more segments of the liver can be excised; one liver is excised when ICGR15 is between 10% and 20%