Research Of ICGR15 In Evaluating Risk Of Hepatectomy In Patients With Liver Cancer In The Child-Pugh A

BackgroundHepatocellular carcinoma(HCC) is one of the most common malignancy globally, ranking NO.6. cancer incidence, mortality rate No.3. At present, surgical treatment is still the most effective treatments for HCC, however, surgical operation will inevitably weaken liver function.72.1～82.3% HCC patients suffer from hepatic cirrhosis the same time in China, which will obviously affected regeneration and reserve function of the liver. If we conduct surgery without considering liver reserve function, not only cannot we reach the expected therapeutic effect, but can exasperate the illness instead and even cause patients died. So, evaluation of hepatic reserve function before liver operation properly is especially important for us to make operation plan and predict risk incidenceAt present, there are so many ways to evaluate hepatic function and reserve function, but witch way could show the most real condition accurately has been a subject what we are exploring. Indocyanine green (ICG) is a kind of non-toxic infrared light-sensitive pigment. ICG combines with serum protein(α-Lipoprotein and albumin),distributes in the blood evenly after two minutes injected to the body, absorbed by hepatic cell high efficiently and selectively, and then secreted into bile gradually in prototype form. ICG is non-toxic and has no side-effect. ICG won't participate in hepatoenteral circulation, bioconversion and lymphatic reflux, can not be metabolized by kidney. Excretion rate of ICG depends on hepatocellular function, the number of hepatic cells and hepatocellular receptors.So, ICG has become the most ideal pigment in evaluating hepatic reserve function. ICGR15 can be used to evaluate hepatic reserve function in clinical works.ObjectiveTo retrospectively observe the significance of indocyanine green retention at 15 minutes (ICGR15) in evaluating risk of Hepatectomy in patient with liver cancer in the A Child-Pugh Classification.MethodsFrom May 2009 to August 2010,65 patients with liver cancer and the A Child-Pugh Classification underwent liver operation in the Department of Hepatobiliary Surgery of the first affiliated hospital of Zhengzhou university. Collected data of these 65 patients from the Medical Records Room, including physical examination,ICGR15 levels, routine liver function examination, blooding clotting examination, routine blood, routine urine,routine feces, AFP, infectious diseases check and imaging examination. All of these 65 patients were divided into two groups according to complications:complication group (n= 28) and non-complication group (n= 37),and three groups according to ICGR15 level:group A (ICGR 15≤10%, n=16),B (10% <ICGR 15≤20%,n=29),C (ICGR 15>20%,n=20). Then analyze the relationship between ICGR15 level and rates of postoperative complication of liver by statistics. ResultsICGR15 level of complication group (24.17%±10.93%) was significantly higher than that of non- complication group (13.11%±6.65%, P<0.001). ICGR 15 level is an independent risk factors of incidence rate of postoperative complications. Incidence of complication increases with the level of ICGR15(complication incidence of group A,B,C are 25%,31%,75% respectively, and difference of them is statistically significantχ2=12.159, P=0.002).ConclusionPreoperative ICGR15 level is a sensitive index for reflecting hepatic reserve function and prediction of risk of liver operation, and more sensitive than biochemical examination of Liver function and Child-Pugh Classification.