中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (08): 645-647.

• 专题笔谈 • 上一篇    下一篇

复杂性肝切除的术前评估与决策

梁力建   

  1. 中山大学附属第一医院肝胆外科，广东广州510080
  • 出版日期:2010-08-01 发布日期:2010-08-02

  • Online:2010-08-01 Published:2010-08-02

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摘要：

复杂性肝切除需要严格掌握手术的适应证和禁忌证。术前应对病人的全身情况、手术的危险性、肝脏的代偿能力作出准确的估计。除了常规的肝功能检查以外，目前估计肝脏功能的常用方法包括（CTP）评分、终末期肝病模式评分系统（MELD）、吲哚青绿15min残留率（ICG R
15）、糖耐量曲线（OGTT）等，在亚洲地区以ICG R15较为准确实用。此外，近年影像学3D图像及体积测量软件的发展使得术前计算残留肝体积（FRLV）成为可能。如果肝硬化病人的ICG R15<10，FRLV>50％应该是安全的。在减少肝切除出血的技术中，尽管有不少新的器械，但钳夹法断肝仍然是值得应用的方法。最近出现的射频消融器Habib 4×可能使断肝过程中出血进一步减少。

关键词: 复杂性肝切除, 肝功能

Abstract:

Preoperative evaluation and decision of complicated hepatectomy        LIANG Li-jian. Department of Hepatobiliary Surgery, the First Hospital of SUN Yat-sen University, Guangzhou 510080, China
Abstract    Both surgical indications and contraindications should be strictly held in complicated hepatectomy. Accurate evaluation of patient’s general condition, surgical risks and liver function compensation should be carried out before surgery. Aside from conventional liver function tests, commonly used techniques include Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD), indocyanine green retention rate at 15 minutes (ICG R15) and oral glucose tolerance test (OGTT), with ICG R15 as the most accurate and practical in Asian areas. In addition, development of 3D imaging techniques and volume measurement software make it possible to predict future remnant liver volume（FRLV）. If ICG R15 is less than 10 minutes in cirrhotic patient, FRLV larger than 50％ should be safe. As for techniques used for blood control in hepatectomy, clamp crushing remains the most commonly used method despite the occurrence of many new types of equipment. Recently used four-prong radiofrequency transection device (Habib 4×) might further reduce blood loss in hepatectomy.

Key words: complicated hepatectomy, liver function