Preoperative Standardized Residual Liver Volumn Ratio Combined With ICG R15 And Prealbumin To Analyze Predictive Value Of Pstoperative Hepatic Dysfuncion In Large Hepatocellular Carcinoma

Objective: The preoperative retention rate of standardized residual liver ratio(SRLVR)combined with indocyanine green for 15 minutes(ICG R15)and the prealbumin(PA)were evaluated,so as to analyze the value of predicting postoperative liver function compensation ability of patients with large liver cancer,and establish a prediction model to provide a new basis for clinical practice.Methods: The data of 88 patients will be collected.These 88 patients are the ones who underwent radical resection of large hepatocellular carcinoma in hepatobiliary surgery department of the first affiliated Hopsital of Guangxi Medical University from October 2015 to January 2017.The preoperative CT images of 88 patients were made into 3D reconstructed and SRLVR was calculated by simulated operation.Indocyanine green scavenging test was performed to obtain ICG R15 on 88 patients within 5 days before surgery.AndPA was obtained by the first liver function after admission.Then,Based on their livers’ compensation function,the patients was grouped according to postoperative biochemical indexes,and retrospective analysis was performed among groups.Results: Among the 88 patients with liver cancer,61(69.3%)cases showed postoperative mild hypohepatia,and 27(30.7%)cases presented moderate or severe hypohepatia.Univariate analysis of the two groups showed that there were significant differences in SRLVR,PA and ICG R15: moderate or severe hepatic dysfunction compensatory insufficiency group was significantly higher than mild hepatic dysfunction compensatory insufficiency group in ICG R15,and SRLVR and PA were significantly reduced,the difference was statistically significant(P < 0.05).Multivariate logistic regression analysis showed that SRLVR,PA and ICG R15 were independent risk factors of postoperative moderate or severe liver dysfunction,among which ICG R15 was the protective factor and the risk factors for SRLVR and PA.Then,according to logistic regression coefficient and constant terms,the regression model Y=-5.701 SRLVR + 0.34 R15-0.017 PA + 4.622(SRLVR,PA and ICG R15 were the measured values)was constructed,and the ROC curve was drawn to calculate the Youden index.The Youden index showed that the optimal critical value for predicting postoperative moderate or severe hypohepatia was-2.053,with the sensitivity was 81.5% and the specificity was 91.2%.Conclusion: Preoperative 3D reconstruction technology plays an important guiding role in the safety of hepatectomy.SRLVR,ICG R15 and PA are indicators reflecting liver reserve function,which can predict liver function recovery after hepatectomy.But there are certain limitations when it is used alone.It is feasible to combine SRLVR,PA and ICG R15 together to predictpostoperative hepatic dysfunction in patients with large liver cancer.