Clinical And Experimental Research About Hepatic Function Reserve Test Before Hepatectomy And In Obstructive Jaundice Status

Object (1) To evaluate the effect of PDD-ICG test on assessing hepatic function reserve. (2) To explore the method for assessing hepatic function reserve by combining function test with volume measurement. (3) To research the method for assessing hepatic function reserve in obstructive jaundice status.Method (1) Fifty-one patients aimed to accept hepatectomy were accepted in the study. Each patient accepted common liver function test and PDD-ICG test before operation. Patients were grouped according to post-operative liver function, and the indexes before operation were compared. Meanwhile, Patients were grouped by K and R₁₅, and the liver dysfunction rates were compared statistically. (2) Twenty-eight patients who accepted hepatectomy were accepted. All patients accepted common liver function test, PDD-ICG test and liver volume measurement. Patients were grouped and indexes were compared in the same way as we done in study 1. Furthermore, Patients were grouped by K_esti and R_15esti, and the liver dysfunction rates were compared statistically. (3) Obstructive jaundice model were made in rabbits by common bile duct ligation. Common liver function test, ICG test, IVGGT test and Arg-CR test were done at the same time in models. Liver tissue ATP concentration was measured as the standard of liver function reserve.Result (1) Patients were divided into compensate group(n=34), slight decompensate group(n=15) and severe decompensate group(n=2). Between the first two group, Child-Pugh score and common liver test before operation had no statistical difference (P>0.05), While indexes of PDD-ICG test including K, T_1/2, R₅, R₁₀, R₁₅(P<0.05) but EHBF(P>0.05) had. According to K, the rate of liver dysfunction in group A(K<0.156), B(0.156≤K≤0.232) and C(K>0.232) were100.0%, 38.5% and 18.8%(P<0.05), respectively. According to R15, The decompensate rate in group A (R15<10%) and B (R15>10%) was 24.4% and 100.0%, respectively (P<0.01).(2) Patients were divided into compensate group (n=17) and decompensate group (n=ll). Child-Pugh score, common liver test and volume indexes (PHRR, RLV) had no statistical difference (P>0.05), While K, Ri5, K^i and Ri5esti had. According to Kesti, the decompensate rate in group A(Kestj<0.156) and BCKesti^O. 156) was 70.0%, 22.2% (PO.05), respectively. According to R15esti, The decompensate rate in group A (Ri5esti<10%) and B (Ri5esti>10%) was 23.8% and 85.7%, respectively (PO.01). Correlation analysis revealed significant correlation between K and K^ti, R15 and Ri5esti(P<0.01). There were five patients whose PHRR were more than 30%, while R15 were all less than 10%. Risesti was calculated and three patients' who belonged to compensate group Ri5esti were far away from 10%. The other two patients' Risesti was 14.8% and 9.35%, who occurred liver dysfunction after operation.(3) The model were grouped as A(l-week ligation, n=6), B(2-weeks ligation, n=4) and C(fake operation, n=6). ATP concentration had no difference between A and C(P>0.05), but between A and B, B and C (P<0.01). Common liver function test in group A and B were significantly different than that of group C (P<0.05). There was no typical P or L type curves presented in IVGGT test. The curve of A and B was parallel and that of group C slightly crossed them. R15 had boundary difference between A and C(P=0.059), and significant difference between A and B, B and C (P<0.05), the characteristic of difference between groups is not similar with that of ATP. The characteristic of difference between groups of Arg-CR test was fitted to that of ATP, and Ke and ATP had significant correlation (r=0. 7486,P<0.01).Conclusion(1) PDD-ICG test is an effective and simple way to evaluate hepatic reserve.(2) ICG test combined with liver volume measurement is a nice way to evaluate hepatic function reserve, and the new effective indexes are K^i and R15esti-Risesti is prior to traditional indexes in major hepatectomy risk evaluation.(3) In obstructive jaundice status, common liver function test, ICG test, IVGGT test can't be used to evaluate the liver function reserve, but Arg-CR is a good method to do it.