The Clinical Application Of Indocyanine Green Test In Hepatic Surgery

BackgroundPartial liver resection one of is the mainly means of the treatment of various liver diseases, and the postoperative residual liver dysfunction is an important factor affecting the clinical outcome. The preoperative accurate assessment of liver reserve function is able to reduce the postoperative liver dysfunction rate, an improve prognosis. The clinical evaluation of liver reserve function is various, such as the serum biochemical examination of liver; clinical scoring system of liver function; quantitative test; imaging evaluation etc. Other studies have shown that the ICG plasma clearance test is a good index in evaluation of liver reserve function.ObjectiveBy retrospective study, we want to evaluated the liver reserve function throuh indocyanine green test for liver resection patients and predict the value in patients with impaired liver function after partial hepatectomy.MethodReview of general surgery department of Beijing Hospital in82cases of patients with liver disease, who underwent Child-Pugh grade and MELD score according to the laboratory indexes and PDD-ICG test, in order to research the correlation between PDD-ICG index and Child-Pugh classification and MELD scoring.Review of general surgery department of Beijing Hospital in42cases of patients with liver disease performed partial hepatectomy operation. The patients had all underwent routine physical examination, liver function, blood coagulation function examination, and imaging examination and PDD-ICG test during preoperative and postoperative, and Child-Pugh grade and MELD score were rated before and after operation. According to patients in the third days postoperative with Child-Pugh grade, MELD score, to investigate the clinical value of PDD-ICG test in predicting the postoperative liver function damage.ResultThe patients age, gender, body surface area, past medical history were of no significant difference in Child-Pugh grade A and grade B group, while the difference of PDD-ICG test results of K, R15, R15m and effective hepatic blood flow index has significance (P<0.05). Correlation analysis showed that the Child score and the K value of the correlation coefficient-0.59(P<0.01), negative correlation, and the R2of curve fitting is0.75; The Child score and R15correlation coefficient was0.59(P<0.01), positive correlation, and the R2of curve fitting is0.78; Child score and R15m correlation coefficient was0.59(P<0.01), positive correlation; Child score and effective hepatic blood flow correlation coefficient-0.67(P<0.01), negative correlation, and the R2of curve fitting is0.59.In the Child-Pugh grade A group, central blood volume>2.10L could make the postoperative liver dysfunction decreased (sensitivity0.8, specificity0.9) by excising one segment of liver; central blood volume>2.25L could make the postoperative liver dysfunction decreased (sensitivity0.8, specificity0.9) by excising two segments of liver; central blood volume>2.36L could make the postoperative liver dysfunction decreased (sensitivity0.6, specificity0.9) by excising more than three segments of liver.Patients with the MELD score of less than9, central blood volume>2.07L could make the postoperative liver dysfunction decreased (sensitivity0.7, specificity0.9) by excising one segment of liver; central blood volume>2.21L could make the postoperative liver dysfunction decreased (sensitivity0.8, specificity0.9) by excising two segments of liver; central blood volume>2.38L could make the postoperative liver dysfunction decreased (sensitivity0.6, specificity0.9) by excising more than three segments of liver.After controlling for confounding factors, preoperative MELD score system and PDD-ICG test were correlated with the results of K, R15, effective hepatic blood flow.Patients with preoperative and postoperative Child grade increased in the control of the range of operation factors, has nothing to do with the PDD-ICG test of K value and R15value (P>0.05) before operation; but associated with central blood volume (P<0.05), the correlation coefficient is-0.38, the negative correlation.patients with preoperative and postoperative MELD score was not correlated with age, sex, body surface area and past medical history; independent of preoperative PDD-ICG test of K value, R15value, R15m value; and the associated with resection of liver tissue outside the product (P<0.05), correlation coefficient were all positive, positive correlation.ConclusionPDD-ICG test has the advantages of simple, convenient, minimally invasive, not only for patients with preoperative evaluation of liver reserve functional, but also has some predictive value in the compensatory ability of postoperative liver.