The Guiding Significance Of The Comprehensive Evaluation Of Liver Reserve Function To The Hepatectomy In Perioperative Period

Objective:The study was to investigate on the guiding significance of the comprehensiveevaluation of liver reserve function to the hepatecto-my in perioperative periodcombined with multiple index.Method:The subjects with a total number of98suffered from hepatectomy were selected fromDecember2011to October2013in Hepatopanereatobiliary Surgery Department of TheSecond Hospital of Jilin University, they were undertaken with routine examinations,such asHepatic function,Coagulation Function,Serum Prealbumin,Doppler Ultrasound,Computerized Tomography, Indocyanine Green Retention Rate at15min(ICGR15) et al.Then the ICGR15values were classified as follows: Group A(ICGR15≤10%),GroupB(10%<ICGR15<20%),Group C(ICGR15≥20%);the pathological sections were dividedinto Malignant Tumor Group and Non-Malignant Tumor Group according to standard ofChild-pugh grading score;The cases were divided into complications(Group N) andnon-complications(Group M) after operation on account of whether they have complicationsor not. Then it took a comprehensive analysis on the patients with different groupsaccording to the factors as the Child-Pugh Grading Score,Serum Prealbumin (PA),Indocyanine Green Retention Rate at15min et al, it also compared the differences andchanges on the index of liver reserve function in different groups.Results:1. Among a total of98cases of liver operation,86patients wereMalignantTumor,27patients had hypohepatia in postoperative period,the occurrence rate was31.4%;12patients were Non-Malignant Tum-or,2patients had hypohepatia in postoperative period,the occurrence rate was16.7%.There wasn’t a statisticalsignificance by chi-square,and there were no relations between the occurrence ofhypohepatia after liver neoplasm dealt with hepatectomy and liver neoplasm.2.98patients with liver neoplasm in preoperative period went on the Child-PughGrading Score in terms of biochemical index ofliver function, which mainly compared the occurrence rate and the differences ofhypohepatia in postoperative period between Child A Grading and Child B Grading,the patients with Child C Grading belong to surgical contraindication. When liverfunction grading wasChild A Grading,the occurrence rate of hypohepatia of patientswithhepatectomy in postoperative period was7.5%;When liver function grading isChild B Grading, the occurrence rate of hypohepatia of patients with hepatectomy inpostoperative period was31.8%,there was a significant statistical significance（0.01P0.05） between the two groups.3. In terms of the Child-Pugh Grading Score,the ICGR15values were classified asfollows:Group A(ICGR15≤10%);Group B(10%<ICGR15<20%), Group C(ICGR15≥20%).(1)When it was Child A Grading, the occurrence rate of hypohepatia of patientswith hepatectomy in postoperative period was respectively as follows:2.7%,27.2%,50.0%.Among the three groups went two groups of comparison, therewas a significant statistical significance between Group A and Group B（χ2=4.10,P=0.03）;There was not a statistical significance between Group B andGroup C（χ2=1.32, P=0.27）;there was a significant statistical significance betweenGroup A and Group C（χ2=8.66,P=0.01）.(2)When it was Child B Grading,the occurrence rate of hypohepatia of patientswith hepatectomy in postoperative period was respectively as follows:14.3%,3.8%,00%.Among the three groups went two groups of comparison, there wasa significant statistical significance between Group A and Group B（χ2=5.21,P=0.01;there was not a statistical significance between Group B and GroupC（χ2=1.27,P=0.21）. According to the statistical results, on the premise that Child-Pugh Grading Scoreis the same, the Indocyanine Green Retention Rate at15min was smaller,theoccurrence rate of hypohepatia of patients with hepatectomy in postoperative periodwas lower,the liver function of recovery in postoperative period was better.4. According to the Child-Pugh Grading, there was a significant statisticalsignificance (P<0.05)between the PA in preoperative period of liver functionrecovered well group and Compensatory liver function compensated not well group.Itwas proved that PA which was one of the liver reserve function indexes can be used inthe study.5. According to the Child-Pugh Grading Score,the PA values were divided into twogroups: PA≥100mg/L and PA<100mg/L.(1) When it was Child A Grading, the occurrence rate of liver functioncompensated not well of patients with hepatectomy in postoperative period wasrespectively as follows:4.9%,38.5%;there was a significant statistical significance（χ2=7.1,P=0.01） between the two groups.(2) When it was Child B Grading, the occurrence rate of liver functioncompensated not well of patients with hepatectomy in postoperative period wasrespectively as follows:15.6%,66.7%;there was a significant statistical significance（χ2=8.61,P=0.01） between the two groups.Conclusion:The comprehensive application of pre-ICGR15,PA and Child-Pugh can predictliver compensatory ability of the patients with hepatectomy in postoperative periodaccurately.