Application Value Of Indocyanine Green Excretion Test And Child-Pugh Classification In Hepatolithiasis Hepatactomy

Objective: To investigate the value of indocyanine green(ICG)excretion test in preoperative evaluation of hepatolithiasis surgery and the clinical significance of Indocyanine green retention rate at 15 min(ICG-R15)?Child-Pugh classification in hepatolithiasis hepatactomy.Methods: Retrospective analysis of 110 cases of hepatolithiasis in Chenzhou First People's Hospital affiliated to the University of South China from 2019-01-01 to 2019-12-31,The subjects were classified into A grade(n=74 cases),B grade(n=33cases)and C grade(n=3cases)according to the Child-Pugh classification.The hepatectomy methods can be divided into three types: liver resection in half liver range,liver resection in two segment liver range and liver resection in one segment liver range(local liver resection).The ICG excretion test was completed before operation.According to the difference of the measured ICG-R15,They were divided into 3 groups:ICG-R15<10%,10%?ICG-R15<25%,ICG-R15?25%.Statistical analysis and comparison the difference of postoperative liver dysfunction rate,postoperative liver failure rate after hepatectomy.Results :(1)The patients in the same grade Child-Pugh A and Child-Pugh B were divided into three groups: ICG-R15<10%,10% ?ICG-R15<25%and I CG-R15?25%.There was no significant difference in preoperative general data between the three groups(P>0.05),and the sample size of Child-Pugh C grade was few,which was not included in the general data statistics.(2)There were significant statistical significance in ICG-R15 comparing the postoperative liver dysfunction rates in three groups : ICG-R15 < 10%,10% ?ICG-R15< 25% and ICG-R15?25%(P<0.05).There were significant statistical significance Child-Pugh comparing the postoperative liver dysfunction rates in three groups: grade A,grade B and grade C(P<0.05).(3)At the same Child-Pugh A grade,the difference of postoperative liver dysfunction rate between ICG-R15 groups was statistically significant(P<0.05).At the same Child-Pugh B grade,comparing the difference of postoperative liver failure rate among three groups,there was no significant difference between 10%<ICG-R15 group and 10% ?ICG-R15<25% group(P>0.05),the difference was statistically significant compared with ICG-R15?25% group(P<0.05).(4)Comparing the ICG-R15 levels of each Child-Pugh grades,the difference were statistically significant(P<0.05).Conclusions :(1)When the Child-Pugh classification is A grade and the ICG-R15<10%,the risk of liver dysfunction is few,and it is estimated that it can tolerate liver resection in half liver range.(2)When the Child-Pugh classification is B grade,the ICG-R15<10% and 10% ?ICG-R15<25%,the risk of liver failure after hepatectomy is significantly reduced.it is estimated to be able to tolerate within two segments of the liver resection.(3)When the Child-Pugh classification is A grade and ICG-R15?10%,the risk of liver dysfunction after hepatectomy is increased,when the Child-Pugh classification is B grade and ICG-R15?25%,it should also be careful to select local liver resection.