关键词: 吲哚菁绿清除试验, 肝脏储备功能, 肝脏硬度值, 原发性肝细胞癌, 肝功能不全

Abstract: Objective To evaluate the hepatic reserve function of patients with primary hepatocellular carcinoma (HCC) by indocyanine green (ICG) retention test before resection, to predict postoperative hepatic dysfunction, and to analyze the relationship between postoperative liver function recovery and preoperative liver stiffness measurement (LSM) value.Methods A total of 64 patients with HCC who underwent selective surgeries in our hospital from December 2015 to June 2017 were enrolled. All subjects accepted preoperative ICG retention test, ICG 15-minute retention (ICG-R15), ICG-R10, ICG-R5, effective blood flow and ICG elimination rate (ICGK) were recorded. All subjects were examined by Fibroscan-502 to obtain the LSM values. Biochemical indexes of liver function were detected to confirm the Child-Pugh classification. The recovery of liver functions was analyzed after the operation. Results ① Among the 64 patients, there were 53 cases of Child-Pugh A and 11 cases of Child-Pugh B. According to the classification of liver function, statistical analysis showed that there were significant differences between the 2 groups in ICG-R15, ICG-R10, ICG-R5, effective blood flow, ICGK, preoperative alanine aminotransferase (ALT), preoperative aspartate aminotransferase (AST), cholinesterase, total bilirubin and direct bilirubin (P<0.05). ② According to the ICG-R15 values, they were divided into 3 groups: less than 10%, between 10% and 20%, more than or equal to 20%. The number of cases in each group was 38, 11 and 15, respectively. There were 7, 4 and 8 cases who had postoperative liver dysfunction in the 3 groups, the incidence was 18.4%, 36.4% and 53.3%, respectively. There was significant difference among the 3 groups (P<0.05). ③ In the Child-Pugh A group, R15 was associated with preoperative ALT, preoperative AST, cholinesterase, total bilirubin, and direct bilirubin. The correlation coefficients were 0.361, 0.486, -0.526, 0.41, and 0.327, respectively. ④ The difference of preoperative LSM value between the liver dysfunction and the non-hepatic dysfunction groups was statistically significant (P<0.05).Conclusion The ICG retention test and LSM can be used to evaluate preoperative liver reserve function in patients with primary HCC and to predict the risk of postoperative liver dysfunction.

Key words: Indocyanine green retention test, Liver reserve function, Liver stiffness measurement, Primary hepatocellular carcinoma, Liver dysfunction