目的 探讨吲哚菁绿15 min清除率(ICG-R15)联合三维影像重建在术前评估肝癌的优势及对肝切除手术疗效的影响。方法 回顾性分析2018年1月至2021年1月在济宁市第一人民医院术前行三维影像重建评估(试验组，n=65)与传统CT评估(对照组，n=70)的肝癌患者资料，所有患者术前均行ICG-R15试验。试验组中采用开腹手术和腹腔镜手术者分别为45、20例，对照组中分别为50、20例。收集两组术前实验室检查、术中相关指标及术后实验室检查数据，比较两种评估方式对肝癌开腹手术和腹腔镜手术疗效的影响。结果 开腹手术中:与对照组比较，试验组手术时间、术后引流管拔出时间明显缩短，术中失血量明显减少，术后并发症发生率、术后7 d直接胆红素及AST水平明显降低(P＜0。05);两组术中输血率、术后住院时间、术后7 d总胆红素、ALT、清蛋白水平及凝血酶原时间无明显差异(P＞0。05)。腹腔镜手术中:与对照组比较，试验组术后住院时间、引流管拔出时间明显缩短，术后7 d AST及ALT水平明显降低(P＜0。05)，其余观察指标均无明显差异(P＞0。05);对照组中3例因腹腔镜术中探查无法切除而中转开腹。与对照组比较，试验组术前评估肝脏肿瘤数量及Couinaud分段定位准确率(96。9％vs。85。7％)、肝血管变异术前评估准确率(100。0％vs。53。8％)更高，实际切除范围＞术前预测范围患者百分比更低(7。7％vs。20。0％)，差异均有统计学意义(P＜0。05);两组门静脉受侵术前评估准确率无明显差异(P＞0。05)。结论 ICG-R15联合三维重建技术较联合传统CT在肝癌术前评估中更具优势，且有助于减少术中出血，缩短手术时间，对患者预后具有积极作用。
Clinical study of ICG-R15 combined with three-dimensional image reconstruction technology in preoperative evaluation of liver cancer
Objective To explore the advantages of indocyanine green clearance rate at 15 min(ICG-R15)combined with three-dimensional image reconstruction technology in preoperativ evaluation of liver cancer,as well as its impact on the efficacy of liver resection surgery.Methods The data of the patients with liver cancer undergoing preoperative three-dimensional image reconstruction evaluation(experimental group,n=65)and traditional CT evaluation(control group,n=70)in the Jining Municipal First People's Hospital from January 2018 to January 2021 were retrospectively analyzed.All patients performed the ICG-R15 test be-fore operation.In the experimental group,45 cases adopted laparotomy and 20 cases adopted laparoscopic sur-gery,which in the control group had 50 cases and 20 cases,respectively.The data of preoperative laboratory tests,intraoperative related indicators and postoperative laboratory tests were collected in the two groups.The influences between the two kinds of evaluation modes on the effects of laparotomy and laparoscopic surgery in liver cancer were compared.Results In laparotomy,compared with the control group,the operation time and postoperative drainage tube extraction time in the experimental group were significantly shortened,the intrao-perative bleeding volume was significantly decreased,the incidence rate of postoperative complications,direct bilirubin and AST levers on 7 d after operation were significantly decreased(P＜0.05);there were no statis-tically significant differences in the intraoperative blood transfusion rate,postoperative hospitalization dura-tion,levels of total bilirubin,ALT and albumin and prothrombin time on 7 d after operation between the two groups(P＞0.05).In laparoscopic surgery,compared with the control group,the postoperative hospitalization duration and postoperative drainage tube extraction time in the experimental group were significantly short-ened,the levels of AST and ALT on 7 d after operation were significantly decreased(P＜0.05);there was no statistically significant difference in the other observation indicators between the two groups(P＞0.05);in the control group,3 cases were converted to laparotomy due to inability to excision during laparoscopic explo-ration.Compared with the control group,the accuracy rate of preoperative evaluation of the number of liver tumors and Couinaud segmentation localization(96.9％vs.85.7％)and preoperative evaluation of liver vas-cular variation(100.0％vs.53.8％)were increased in the experimental group,the percentage of the patients with actual resection range greater than preoperative prediction range was lower(7.7％vs.20.0％),and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the accu-racy of preoperative evaluation of portal vein invasion between the two groups(P＞0.05).Conclusion ICG-R15 combined with three dimensional reconstruction technology in preoperatively assessing liver cancer has more advantages compared with combined traditional CT,moreover which is conducive to reduce intraoperative bleeding,shorten operation time and has the positive effect on the patients'prognosis.
indocyanine green clearance test3D reconstructionliver cancerliver cirrhosispreopera-tive evaluation
万方数据
维普
