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目的:探讨适合我国乙肝相关性肝癌肝切除患者的肝脏储备功能的评估方案。方法:回顾性分析连续129例因乙肝相关性肝癌行肝部分切除术患者的临床资料,比较3种经典的肝脏储备功能评估方案预测术后肝衰竭发生的特异性与敏感性。结果:全组共有13例(10.1%)患者术后发生肝衰竭(肝衰竭组),其中1例院内死亡;116例术后术后肝功能恢复良好(肝功能恢复良好组)。肝衰竭组患者行大块肝切除比例、术前吲哚青绿15 min滞留率(ICGR15)及年龄明显高于术后肝功能恢复良好组(均P<0.05)。ICGR15评估方案与决策树(Decision Tree)评估方案均具有评估价值(均P<0.01)。而Decision Tree评估方案预测术后肝衰竭的敏感性、特异性、阳性预测值及阴性预测值分别为95%,84%,64%和98%,均优于ICGR15评估方案。结论:Decision Tree方案适用于乙肝相关性肝癌肝切除患者的肝脏储备功能评估。
OBJECTIVE: To evaluate the assessment of liver function in patients undergoing hepatectomy for hepatitis B-related liver cancer in China. Methods: The clinical data of 129 consecutive patients undergoing partial hepatectomy for hepatocellular carcinoma (HCC) were retrospectively analyzed. Three classic liver function assessment programs were compared to predict the specificity and sensitivity of postoperative liver failure. Results: A total of 13 patients (10.1%) in the whole group had liver failure (liver failure group) postoperatively, of which 1 died in hospital and 116 patients recovered well after operation (good liver recovery group). In the liver failure group, the ratio of chunk resection, preoperative indocyanine green 15 min retention rate (ICGR15) and age were significantly higher than that of postoperative recovery of liver function (all P <0.05). Both the ICGR15 evaluation and Decision Tree evaluation programs have evaluation values (all P <0.01). However, the sensitivity, specificity, positive predictive value, and negative predictive value of the Decision Tree assessment program for postoperative liver failure were 95%, 84%, 64% and 98%, respectively, better than the ICGR15 assessment program. Conclusion: The Decision Tree protocol is suitable for the assessment of liver reserve in patients with hepatectomy associated with liver cancer.