摘要目的 探讨吲哚菁绿(ICG)实验对于评估巴塞罗那(BCLC)-B/C期肝癌患者经导管动脉化疗栓塞(TACE)术后围手术期出现肝功能衰竭的价值.方法 分析54例行吲哚菁绿实验并行TACE治疗的BCLC-B/C期患者的临床资料,根据TACE术后是否发生肝衰竭分为肝衰竭组与非肝衰竭组,记录并分析两组患者临床生化指标,吲哚菁绿实验15 min滞留率(ICG-R15),Child-Pugh(CP)分级及终末期肝病模型(MELD)评分的差异.结果 两组一般资料差异无统计学意义(P＞0.05);两组ICG-R15: (27.3±5.0)％、(18.3±5.5)％;Child-Pugh分级:8.75±0.5、6.37±1.0;MELD评分:(23.0±7.5)、(16.6±5.9)分,差异均有统计学意义(P＜0.05).ICG-R15对于评估TACE术后出现肝功能衰竭的敏感性为87.5％,特异性为13.0％.ICG-R15与CP分级、MELD评分呈显著正相关(r =0.691、0.656,P＜0.01).结论 ICG-R15是评估肝脏储备功能的良好指标,其结合Child-Pugh分级及MELD评分能更好的评估肝脏储备功能.当ICG-R15＜ 20％,Child-Pugh分级A级,MELD评分＜20分时,行TACE治疗较为安全;当ICG-R15＞ 30％,MELD评分＞30分时,禁忌任何有损肝功能的治疗以免发生肝衰竭;介于两者之间的患者,可先行保肝治疗,待肝功能好转或者肝功能分级降低后再行TACE治疗,以减少术后肝衰竭的发生率.

abstractsObjective To explore the value of indocyanine green tesin evaluating livefailure aftesuper-selective trans-arterial chemoembolization (TACE) fostage B/hepatocellulacarcinomin BarcelonClinical LiveClassification (BCLC) classification.MethodAnalyse the clinical datof 54 patientof BCLC-B/stage.According to whethePostoperative LiveFailure (PLF) appeared afteTACE, they were divided into hepatifailure group and non-hepatifailure group.Respectively record and analysithe chnical biochemical parameters, the indocyanine green retention rate a15 min(ICG-R15), Child-Pugh scores, and Model foEnd-stage LiveDisease (MELD) scorebetween the two groups.ResultContrasto non-PLF group, the general datof PLF group have no statistical significance (P ＞0.05).The numerical value of ICG-R15 : (27.3 ±5.0)％, (18.3 ±5.5)％;CP: 27.3 ± 5.0, 18.3 ±5.5;MELD: 23.0 ±7.5, 16.6 ±5.9.And the difference between the two groupare significantly (P ＜ 0.05).The sensitivity of ICG-R15 foestimating PLF i87.5％, and the specificity i13.0％.ICG-R15 ipositively correlated with CTP and MELD score system (P ＜0.01).Conclusion ICG-R15 isensitive predictofoevaluating livereserve function.When combined with CP and MELD score system, ICG-R15 would help umake bettedecision on therapeutimethodfopatientwith HCC.When the ICG-R15 ＜20％ , CP grading in level and MELD ＜20, it' safe to take TACE.When the ICG-R15 ＞ 30％ and MELD ＞ 20, we advise notaking any surgery in case of the happening of livefailure.When resultare between the above two classification, the recovery of livefunction irecommended before TACE.