本文選題：肝功能儲備 + 吲哚氰綠實驗��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的 分析肝硬化肝癌病人的肝儲備功能及肝臟體積與肝硬化肝癌術(shù)后并發(fā)癥的產(chǎn)生及肝功能改變的關(guān)系，為肝臟手術(shù)提供臨床參考。 資料與方法 對吉林大學(xué)中日聯(lián)誼醫(yī)院肝膽胰外科2012年2月至2013年12月在我院行肝臟切除術(shù)的40例肝硬化肝癌的患者進行回顧性分析。術(shù)前患者均行Child—Pugh肝功能分級評分（符合2004年中華外科學(xué)會肝膽外科學(xué)組修訂的原發(fā)性肝癌外科治療方案的選擇[1]）。脈動色素濃度（PPD）法檢測吲哚氰綠15分鐘滯留率（ICGR15）。采用日本320排螺旋CT進行肝臟掃描，對獲得的數(shù)據(jù)進行三維重建，測量肝臟體積切除率LVRR（Liver Volume Removal Rate）=（切除的肝臟體積—腫瘤體積）/（全肝體積—腫瘤體積）x100%。依據(jù)Child—Pugh肝功能分級評分系統(tǒng),根據(jù)術(shù)后肝臟功能恢復(fù)情況分為肝功能A級（A組）：總膽紅素34umol/L，白蛋白35g/L，凝血酶原時間延長4s，無腹水，，無肝性腦病。肝功能B級（B組）：34umol/L≤總膽紅素≤51umol/L，35g/L≥白蛋白≥28g/L，4s≤凝血酶原時間延長≤6s，輕度腹水，1㧟2級肝性腦病。肝功能C級（C組）：51umol/L 總膽紅素，白蛋白28g/L，6s凝血酶原時間延長，中度或重度腹水，3㧟4級肝性腦病。根據(jù)術(shù)后有無胸腔積液、腹腔積液、膽汁瘺、消化道出血、腎衰及肝衰等分為有并發(fā)癥及無并發(fā)癥組。 結(jié)果 當(dāng)ICGR15≤15%時LVRR與術(shù)后并發(fā)癥之間的相關(guān)性無顯著統(tǒng)計學(xué)意義（P＞0.05）。當(dāng)ICGR15在15%－20%之間時LVRR≤30%并發(fā)癥的發(fā)生率明顯少于LVRR＞30%組，有顯著統(tǒng)計學(xué)意義（P＜0.05）。當(dāng)ICGR15≥20%時LVRR與術(shù)后并發(fā)癥之間的相關(guān)性無顯著統(tǒng)計學(xué)意義（P＞0.05）。當(dāng)ICGR15與LVRR值逐漸升高時患者術(shù)后肝臟功能狀態(tài)亦隨之變差，發(fā)生率亦隨之增加。 結(jié)論 1、患者ICGR15≤15%時可耐受較大范圍肝臟體積切除（LVRR30%）。 2、術(shù)前行肝體積及肝儲備功能測定，準(zhǔn)確計算殘肝體積能有效的預(yù)防術(shù)后并發(fā)癥的發(fā)生，減少肝功能損害。
[Abstract]:PurposeTo analyze the relationship between liver reserve function and liver volume in patients with liver cirrhosis and the postoperative complications and changes of liver function in patients with liver cirrhosis and liver cancer, and to provide clinical reference for liver surgery.Data and methodsFrom February 2012 to December 2013, 40 patients with liver cirrhosis and liver cancer underwent hepatectomy in Jilin University Sino-Japanese Friendship Hospital were retrospectively analyzed.All patients were assessed with Child-Pugh 's hepatic function grading before operation (according with the revised surgical treatment plan of primary liver cancer [1]) in 2004 by the Chinese Academy of surgery in Hepatobiliary surgery.The retention rate of indocyanine green for 15 minutes was determined by PPD method.The liver was scanned with 320 slice spiral CT in Japan. The obtained data were reconstructed and the liver volume resection rate (LVRR(Liver Volume Removal volume) was measured.According to the Child-Pugh grading system of liver function, according to the recovery of liver function after operation, liver function grade A was divided into group A: total bilirubin 34 umol / L, albumin 35 g / L, prothrombin time prolonged for 4 s, no ascites, no hepatic encephalopathy.In group B, the prothrombin time was prolonged for less than 6 seconds, and the prothrombin time was prolonged for less than 6 seconds in group B: 34 umol/ L 鈮

本文編號：1761034