肝癌患者肝储备功能检测的意义及护理对策

正肝脏是人体最大的实质性器官以及人体功能最复杂的脏器,有巨大的储备以及再生的能力。肝储备功能检测是评估肝功能的良好指标,因此准确评估肝脏储备功能对预测手术风险性、选择适当的治疗方法,降低手术病史率及术后并发症具有重要意义~([1])。ICG清除试验是目前最能反映有功能肝细胞量的评估方法~([2])。吲哚氰绿清除试验作为动态检测,具有实时、定量评估肝功能的优势,可评估肝脏外科手术患者围手术期的肝脏储备功能,可预测和避免术后肝脏衰竭,评价肝纤     

R15指标和利用16排CT测评肝储备功能相关性研究

目的 ICG清除试验(DDG分析仪检测法)是测定肝脏储备功能的新方法.本文旨在明确DDG检测在测定肝脏储备功能上的准确性,并讨论和评价基于DDG检测的肝脏储备功能与基于螺旋CT体积测定的半肝切除术后肝脏再生情况与肝脏储备功能的相关性意义.方法 本研究收集了152例原发性肝癌患者的病例及随访资料.对每例患者于规则性半肝切除术前通过ICG清除试验检测测定ICG 15min滞留率(R15),并于术前及术后对其进行16层螺旋CT扫描,并测定肝脏体积、残余肝体积,求出残余肝脏术后1个月增殖率以代表残余肝再生能力.同时比较R15和残余肝术后1个月增殖率的相关性.结果 所有患者均能在6～8min内ICG清除试验检测,检测过程中未发现明显的药物副作用及意外情况.本研究原发性肝癌病例中129例患者合并有不同程度的肝硬化,另22例患者合并慢性肝炎,但无明显肝硬化.合并肝硬化组与未合并肝硬化组间R15值差异均具有统计学意义.经相关性分析得出,R15值与Child-Pugh分级评分之间具有良好相关性.残余左半肝组和残余右半肝组再生增长率与DDG R15值之间均具有相关性.结论 ICG清除试验指标(R15)能很好的反映原发性肝癌患者的肝储备功能;R15的数值与肝脏的再生有一定的相关性.     

肝脏储备功能检查的护理配合

肝脏储备功能检查又称ICG清除试验,是作为肝脏相关疾病的常规检查项目,能够客观地反映肝脏功能储备情况,为精准肝切除提供了可靠的数据.肝功能衰竭是肝癌切除术后严重并发症,也是导致术后死亡的主要原因.肝功能衰竭的发生主要与肝硬化引起的肝脏储备功能下降有关,也与手术过程,包括切除肝脏体积,术中出血,阻断门脉血流与否以及围手术期的处理等有关[1].术前正确评估肝脏储备功能,术中合理掌握切肝量,是避免术后肝功能衰竭的重要措施[2].     

吲哚氰绿清除试验在肝硬化患者全凭静脉麻醉术前肝储备功能评估中的应用

目的:评价吲哚氰绿(ICG)清除试验作为肝硬化患者全凭静脉麻醉术前肝储备功能评估的可行性和可靠性、准确性.方法:选择42例择期腹部非肝脏手术的肝硬化患者,肝脏功能Child-Pugh A、B级,ICGR15 0 ～ 10%为A组(n=21),ICGR15 ＞ 10%为B组(n=21).术前进行ICG清除试验,麻醉诱导TCI丙泊酚血浆靶浓度设为3μg/mL,同时输注瑞芬太尼血浆靶浓度4 ng/mL,根据BIS值的变化(40 ～ 60)调整维持麻醉的靶控浓度.结果:在麻醉恢复期,虽然两组患者丙泊酚TCI停止时预期清醒的时间差异无显著性(P ＞ 0.05),但是B组较A组拔出导管时间明显延长, OAA/S评分减低,差异具有极显著性(P ＜ 0.01).结论:ICG清除试验是检测肝储备功能实用可行的理想方法.ICGR15能很好地反映肝硬化患者的肝储备功能,对麻醉恢复情况有良好的预计性.     

脉动色素浓度测定法检测吲哚氰绿清除试验在肝储备功能评估中的应用

目的:探讨脉动色素浓度测定法(pulse dye densito graphanalyzer,PDDG)检测吲哚氰绿(ICG)清除试验在肝炎后肝硬化患者术前肝储备功能评估中的作用。方法:用PDDG法进行ICG清除试验,分析其在104例肝炎后肝硬化患者在术后恢复方面与Child-Pugh评分的相关性。结果:吲哚氰绿15min潴留率(ICGR15)在术后腹水、白蛋白用量、利尿剂用量、黄疸等方面与Child-Pugh评分有较好的一致性;同时ICGR15较Child-Pugh评分在术后并发症及治疗方面相关系数更高,相关性更强。结论:PDDG试验是行ICG清除试验检测肝储备功能实用可行的理想方法,能很好地反映肝炎后肝硬化、门脉高压症患者的肝储备功能,对手术后恢复情况有良好的预计性。     

肝脏剪切波速度联合临床指标评估肝细胞癌合并乙型病毒性肝炎患者肝脏储备功能

目的 观察肝脏剪切波速度(LSWV)联合临床指标评估肝细胞癌(HCC)合并乙型病毒性肝炎(乙肝)患者肝脏储备功能的价值。方法 前瞻性纳入93例HCC合并乙肝患者，行吲哚菁绿(ICG)排泄试验、常规超声、剪切波弹性成像及血清生化检查，记录其ICG 15 min滞留率(ICG R15)、LSWV、门静脉内径(D_pv)、HCC体积(V),以及谷丙转氨酶(GPT)、谷草转氨酶(GOT)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(γ-GGT)、血清白蛋白(ALB)及凝血酶原时间(PT)。以ICG R15<10%为肝脏储备功能正常，行logistic回归分析，评估肝脏储备功能的影响因素；以多元线性逐步回归分析构建预测ICG R15模型，并观察其预测效能。结果 LSWV、D_PV、GPT和GOT为HCC合并乙肝患者肝脏储备功能异常的影响因素(P均<0.05),其联合评估肝脏储备功能的准确率为72.40%。LSWV、GPT、ALB和PT为HCC合并乙肝患者ICG R15的影响因素(P均<0.05),以之构建的联合模型预测ICG R15的曲线下面...     

肝储备功能定量评估的影像学研究进展

综述肝储备功能定量评估的影像学研究进展。准确评估肝脏储备功能,有利于降低肝脏部分切除术后并发症或肝移植术后移植物原发性无功能和早期移植物功能不良的发生率。     

健康教育在肝储备功能检测患者中的应用

肝脏部分切除术和经皮肝动脉栓塞化疗是治疗肝癌的有效手段，肝癌大多有慢性病史，我国肝癌合并肝硬化者高达85％，硬化的肝脏再生能力差，储备功能降低^[1]，因此，准确评估肝储备功能对预测手术风险性、选择适当的治疗方式、降低手术病死率及术后并发症具有重要意义。吲哚氰绿（ICG）储留率能准确而灵敏地反映肝脏储备功能^[2]。     

声辐射力脉冲弹性成像技术评估肝占位患者肝脏储备功能的临床价值

目的探讨声辐射力脉冲弹性成像（ARFI）技术评估肝占位患者肝脏储备功能的临床价值。方法选择2011年9月至2012年8月解放军总医院86例肝占位患者。其中肝功能Child-PughA级54例,B级18例,C级14例;70例患者进行手术治疗,16例患者采用非手术治疗。采用ARFI技术测量患者肝脏剪切波速度值（SWV）;同时对患者进行吲哚氰绿（ICG）排泄实验,记录ICG血浆清除速率及ICG 15min滞留率。SWV值与ICG血浆清除速率、ICG 15min滞留率的相关性采用Pearson相关分析;SWV值与Child．Pugh分级的相关性采用Spearman等级相关分析。手术治疗患者与非手术治疗患者SWV值比较采用独立样本t检验以患者的临床决策作为金标准,采用受试者操作特性（ROC）曲线评价ARFI技术判断肝占位患者手术可行性的应用价值。结果SWV值与ICG 15min滞留率、ICG血浆清除速率、Child．Pugh分级有相关性（r=0．764,P〈0．001;P0．686,P=-0．000：r=0．864,P=-0．000）。手术治疗患者SWV值为（2．46±0．45）m／s,非手术治疗患者SwV值为（1．54±0．36）m／s,差异有统计学意义（t=-0．80,P=0．000）。ROC曲线显示,当诊断界值为2．06m／s时,约登指数最高为0．775,其相对应的ARFI技术判断肝占位患者手术可行性的敏感度为87．5％,特异度为90．0％。结论ARFI技术可有效评估肝占位患者肝脏储备功能,为临床治疗方式的决策提供帮助。     

吲哚菁绿排泄试验与肝脏储备功能的相关性评价

目的探讨吲哚菁绿（ICG）排泄试验在肝脏储备功能评估中的临床价值。方法选取2012年1月至2014年5月吉林大学中日联谊医院接受吲哚菁绿排泄试验的肝脏疾病患者119例,分别测定ICG 15分钟滞留率（R15）、血浆清除率（K）、有效肝血流量（EHBF）,并采用Child-Pugh分级、MELD评分及t检验、线性回归分析,比较R15、K值与Child-Pugh分级、MELD评分的关系。结果随着Child-Pugh分级的递增,K值和EHBF下降,而R15升高。Child-Pugh A组R15（12.289±12.754）%,K值（0.172±0.069）/min;Child-Pugh B组R15（41.818±17.202）%,K值（0.063±0.026）/min;两组R15、K值比较存在统计学差异（P〈0.05）。将R15、K值与Child-Pugh分级、MELD评分进行相关性分析,均存在良好相关性,R15为正相关,K值为负相关。结论 R15、K值与Child-Pugh分级关系密切,R15相关性更加显著,提示R15是评估肝脏储备功能的准确、灵敏指标。     

Assessment of liver perfusion and function by indocyanine green in the perioperative setting and in critically ill patients

Indocyanine green (ICG) is a water-soluble dye that is bound to plasma proteins when administered intravenously and nearly completely eliminated from the blood by the liver. ICG elimination depends on hepatic blood flow, hepatocellular function and biliary excretion. ICG elimination is considered as a useful dynamic test describing liver function and perfusion in the perioperative setting, i.e., in liver surgery and transplantation, as well as in critically ill patients. ICG plasma disappearance rate (ICG-PDR) which can be measured today by transcutaneous systems at the bedside is a valuable method for dynamic assessment of liver function and perfusion, and is regarded as a valuable prognostic tool in predicting survival of critically ill patients, presenting with sepsis, ARDS or acute liver failure.     

肝储备功能分析仪两种探头使用的比较

目的比较肝储备功能分析仪鼻夹探头和手指探头的优劣。方法回顾性分析1902例行肝储备功能检查——吲哚菁绿15min潴留率（ICGR15）病例,比较鼻夹探头和手指探头的使用效果。结果得出手指探头的检测失败率和不良反应发生率明显低于鼻夹探头。结论肝储备功能分析仪使用手指探头进行检测时效果好,且操作简便,还可减轻患者的心理障碍,使其更舒适和易于接受,便于临床推广。     

Hepatic phenylalanine metabolism measured by the [13C]phenylalanine breath test

BACKGROUND: The amino acid clearance test including phenylalanine is known to reflect liver functional reserve, which correlates with surgical outcome; however, the procedure is not clinically useful because of its laborious and time-consuming nature. This study evaluates whether phenylalanine oxidation capacity measured by a breath test could reflect liver functional reserve. DESIGN: We determined phenylalanine oxidation capacity in 42 subjects using the L-[1-13C]phenylalanine breath test (PBT). The 13CO2 breath enrichment was measured at 10-min intervals for 120 min after oral administration of 100 mg of L-[1-13C]phenylalanine. Subjects were divided into the following three groups according to their plasma retention rate of indocyanine green at 15 min (ICG R15): Group I (ICG R15 < 10%), Group II (ICG R15 10--20%), and Group III (ICG R15 > 20%). First, we determined the parameters of the phenylalanine oxidation capacity that differentiated these groups and then, using these parameters, we compared the PBT with the ICG clearance test, Child-Pugh classification score and standard liver blood tests. RESULTS: The %13C dose h(-1) at 30 min and cumulative excretion at 80 min were significantly different among the three groups (P < 0.05). These two parameters significantly correlated with the ICG R15, Child-Pugh classification score (P < 0.0001) and results of standard liver blood tests (P < 0.05). CONCLUSIONS: Phenylalanine oxidation capacity measured by the PBT was reduced according to the severity of liver injury assessed by the ICG clearance test, Child-Pugh classification, and standard liver blood tests. These results indicate that the PBT can be used as a noninvasive method to determine liver functional reserve.     

Assessment of liver function by the aminopyrine breath test

The aminopyrine breath-test (ABT) has been proposed as a non-invasive quantitative test of liver function and reserve. To evaluate its usefulness, we compared the ABT with standard liver function tests, Child's classification of liver disease and ICG clearance, as means of assessing liver function in 30 patients with cirrhosis. The cumulative output of 14CO2 in breath during the 6 h following [14C]aminopyrine administration was significantly decreased in the cirrhotic group as compared with control subjects. The severity of liver dysfunction, as assessed by Child's classification, was associated with a progressive and statistically significant impairment of the ABT. There was a good correlation between the ABT and ICG systemic clearance (r = 0.770, P less than 0.001) and also between the ABT and ICG intrinsic clearance (r = 0.885, P less than 0.001), a measure which is independent of hepatic blood flow variations. These results further strengthen the concept that the ABT is a simple non-invasive method to assess quantitatively liver function and reserve, and could be useful in following the evolution of patients with liver disease.     

吲哚菁绿清除试验在肝癌治疗中的应用进展

肝癌是一种严重威胁人类健康的疾病,肝癌治疗前需要进行肝储备功能评估,但由于肝结构与功能的复杂性,目前尚无可全面评估肝功能的方法,吲哚菁绿清除试验作为一种能够动态地、迅速地评估肝储备功能的方法被广泛应用于肝癌治疗中肝储备功能评估。本文分析归纳了吲哚菁绿清除试验在肝癌治疗肝储备功能评估中的应用,得出吲哚青绿清除试验在肝癌治疗尤其在肝切除术时能够准确评估肝储备功能,预测术后肝功能不全。     

Could Ultrasound Elastography Reflect Liver Function?

The purpose of this study was to investigate whether ultrasound elastography reflects liver function reserve relative to liver fibrosis histology. Sixty-five New Zealand rabbits were divided into an experimental group (n?=?45) and a control group (n?=?20). In the experimental group, liver fibrosis (F1–F4) was induced by subcutaneous injection of carbon tetrachloride. Point shear wave elastography and the indocyanine green (ICG) elimination test were performed for the two groups at 4-wk intervals for 56?wk. The liver stiffness value (LSV) and the ICG retention rate at 15?min (ICGR15) were obtained, and the correlation between them was investigated. The median LSVs of stages F0–F4 were 3.92?kPa (1.91–8.53?kPa), 5.02?kPa (2.39–8.91?kPa), 7.87?kPa (5.21–12.26?kPa), 12.83?kPa (5.92–16.79?kPa) and 16.64?kPa (9.76–29.50?kPa), respectively. The median ICGR15 values of stages F0–F4 were 8.7% (4.8%–15.6%), 10.8% (5.6%–20.3%), 19.2% (12.3%–26.7%), 31.0% (20.9%–41.0%) and 45.6% (22.1%–60.9%). There were significant differences in LSVs and ICGR15 values among the different stages of liver fibrosis (p?<0.01). A positive correlation was observed between LSV and ICGR15 (r?=?0.7497, p?<?0.0001). A strong correlation was observed between liver stiffness and liver function reserve, indicating ultrasound elastography may reflect liver function reserve in different degrees of liver fibrosis.     

Two cases of laparoscopic deroofing of giant liver cysts using indocyanine green fluorescence imaging

Laparoscopic deroofing (LD) for giant liver cysts using indocyanine green (ICG) fluorescence imaging was performed in two patients: a 53-year-old man with a 26-cm, symptomatic cyst and a 50-year-old woman with a 13-cm, symptomatic cyst. ICG fluorescence imaging can be used to easily identify the boundary between the liver parenchyma and the liver cyst. No postoperative bile leakage was observed in both patients. ICG fluorescence imaging is expected to become a desirable procedure in LD for giant liver cysts to reduce the occurrence of perioperative complications.     

Hepatocellular carcinoma with indocyanine green excretory defect: a case report and review of the literature

Constitutional indocyanine green (ICG) excretory defect is rare. However, ICG excretory defect concomitant with hepatocellular carcinoma (HCC) is extremely rare, and only six reports of hepatectomy in patients with constitutional ICG excretory defect have been published in the English language literature through 2020. In this study, we report a case of combined HCC and ICG excretory defect and discuss its clinicopathological features and outcomes. The case featured a 68-year-old man who was admitted to the hospital with a diagnosis of resectable HCC. The preoperative ICG retention rate at 15 minutes was 82.9%. Despite this finding, the Child–Pugh assessment and hepatobiliary-specific magnetic resonance imaging (MRI) did not reveal any abnormal findings. Therefore, we diagnosed the patient with constitutional ICG excretory defect and performed partial hepatectomy. For patients requiring hepatectomy, the indications and procedure for surgery should be considered. These should be based on liver function tests such as gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI.     

Establishment of an indocyanine green test using an automatic chemistry analyzer.

The indocyanine green (ICG) clearance test has been used to assess the reserve of hepatic function. This method is based on the spectrometric measurement of its plasma concentration at maximum wavelength of 805 nm, which requires a spectrophotometer and associated maintenance. We established an ICG clearance test using a Toshiba 200FR automatic chemistry analyzer that can be tuned to a wavelength of approximately 805 nm. Five pooled sera spiked from 0 to 4.0 mg/dL were analyzed for linearity test and precision was determined at five levels in the range 0.1-2.0 mg/dL. The ICG retention rate at 15 min (R15) was determined for 38 patients using a conventional method and our method. The ICG clearance test using the automatic chemistry analyzer showed good linearity, and precision ranged from 0.3% to 1.0% for within-run CVs and from 0.6% to 4.7% for total CVs. The degree of agreement between the two methods was also acceptable (mean difference of 1.5%). It is expected that the ICG test using the automatic chemistry analyzer can replace the conventional ICG clearance test, considering the excellent agreement, good precision and linearity over a clinically relevant range.