The Evaluation Value Of ICGR15 Combined With Direct Bilirubin To Prothrombin Time Activity Ratio Index For Liver Function After Left Hemihepatectomy

Background and ObjectiveLiver cancer is a serious threat to human health.With the development of medicine,treatment methods are diversified,but surgical resection is still the most effective method.Posthepatectomy liver failure(PHLF)is the most serious complication of surgery and is closely related to abnormal liver reserve.Indocyanine green retention rate at 15 minutes(ICGR15)is a method for evaluating liver reserve function,which can dynamically reflect liver function.Direct bilirubin and prothrombin time activity are indicators of liver function.Direct bilirubin to prothrombin time activity ratio index(DBPTRI)has been reported to be used to prevent the occurrence of PHLF.Left hemihepatectomy is often used to treat tumors of the left lobe of the liver.The surgical method is relatively fixed and uniform,and the resection volume is relatively constant.Therefore,we combined ICGR15 and DBPTRI to analyze the predictive ability of PHLF after left hemihepatectomy in patients with liver cancer,and then provide new help and guidance for clinical work..MethodsFrom January 2016 to December 2020,a total of 60 patients who underwent open left hemihepatectomy with liver cancer at the Department of general surgery of the affiliated hospital of our school were analyzed retrospectively.The ROC curve was used to compare ICGR15,DBPTRI and The combined area under the curve and the best cut-off value of DBPTRI was obtained.The independent risk factors were PHLF were screened by logistic regression analysis.Groups were grouped according to ICGR15 and DBPTRI to compare the differences in the incidence of PHLF in each group.Results1.There were significant differences in preoperative ICGR15,DBIL,PLT,PTA,DBPTRI,hilar occlusion time and intraoperative blood loss between the two groups(P<0.05);2.Multivariate regression showed that preoperative ICGR15,DBPTRI and hilar occlusion time were independent risk factors for PHLF;3.ROC analysis showed that the areas under the curve of ICGR15,DBPTRI and ICGR15 combined with DBPTRI were 0.757,0.768 and 0.797 respectively,and the results were statistically significant(P<0.05);4.When ICGR15%≤10% and DBPTRI≤7.15 before operation,the incidence of PHLF was 8.8%.When ICGR15≤10% and DBPTRI>7.15 or ICGR15>10% and DBPTRI ≤ 7.15,the incidence of PHLF was 20%.When ICGR15>10% and DBPTRI>7.15,the incidence of PHLF was 43.8%.There was significant difference among the three groups(P<0.05).Conclusion1.The predictive efficiency of ICGR15 combined with DBPTRI in predicting PHLF after left hemihepatectomy is higher than that of both of them,and the predictive efficacy of DBPTRI is better than that of ICGR15;2.For HCC patients undergoing left hemihepatectomy,the preoperative evaluation of liver function with ICGR15 and DBPTRI is helpful to better predict the possibility of PHLF.