肝脏储备功能评价对巨大肝脏肿瘤解剖切除的应用价值

• 作 者: 周俭 於雷
• 机 构: 复旦大学附属中山医院肝癌研究所教育部癌变与侵袭原理重点实验室,
• 出 处: 中国实用外科杂志
• 发表日期: 2004年期
• 关键词: 肝脏储备功能 肝脏肿瘤 肝切除 动态血清学检测 肝体积测定 肝功能衰竭 系统评分 肝脏体积 肝体积 肝脏切除

手术切除是肝脏肿瘤获得根治性疗效的主要手段。但切除肿瘤(特别是巨大肿瘤)后,若剩余肝脏储备功能不足,术后易发生肝功能衰竭,这也是肝外科围手术期死亡的重要原因。因此,准确评估病人术前肝脏储备功能,对病人能否耐受手术、判断术中肝脏切除范围、避免术后出现肝功能衰竭具有重要意义。目前评价肝脏储备功能的主要方法:基于血清(浆)学的肝脏功能动态检测如吲哚氰绿(ICG)试验、单乙基甘氨酸二甲苯胺(MEGX)试验等;系统评分如Child-Pugh评分等;以及肝脏体积测定。术后肝功能恢复取决于剩余肝脏的体积、质量及病人全身情况等多方面。因此,术前要结合多项指标全面、准确、综合评估肝脏储备功能。

Surgical resection is the primary means of achieving radical curative effect in liver tumors. However, resection of the tumor (especially large tumors), if the remaining liver reserve insufficiency, liver failure prone to occur after surgery, which is also an important cause of perioperative death of liver surgery. Therefore, accurate assessment of the patient's preoperative liver reserve function, the patient can tolerate surgery to determine the scope of intraoperative resection of the liver, to avoid postoperative liver failure is of great significance. Currently, the main methods for evaluating liver function reserve are as follows: dynamic liver function tests based on serum (plasma) such as indocyanine green (ICG) test, MEGX test, and system score such as Child-Pugh score Etc .; and liver volume determination. Postoperative liver function depends on the remaining liver volume, quality and patient's general condition and many other aspects. Therefore, preoperative combined with a number of indicators comprehensive, accurate and comprehensive assessment of liver reserve function.