【摘要】 目的:探讨以Child-Pugh分级结合ICG R15、肝瞬时弹性值及肝脏3D打印技术评估肝癌切除手术安全性。方法:选取2016年9月至2017年9月我科室接收肝部分切除的原发性肝癌患者95例作为研究对象,分别于术前1周及术后2周内以Child-Pugh分级与新评分系统评估肝储备功能,了解两种方法预测术后肝功能代偿情况的准确性;将患者分为行肝脏3D打印组与未行肝脏3D打印组,比较两组手术时间、出血量、输血率、并发症率等情况。结果:Child-Pugh分级及新分级预测术后肝功能代偿良好、准确率分别为68.75%、84.91%(P=0.035);Child-Pugh分级及新分级预测术后肝功能代偿轻度不良准确率分别为64.52%、84.21%(P=0.008);行肝脏3D打印组手术时间、出血量、输血率、并发症率分别是(178.3±88)min、380.0 m L、27.87%(17/61)、32.78%(20/61),未行肝脏3D打印技术病例组手术时间、术中出血量、输血率、并发症率分别为(216.1±101)min、450.0 m L、38.23%(13/34)、41.18%(14/34),两组病例对比,各指标差异有统计学意义(P<0.05)。结论:新肝储备评估系统结合肝脏3D打印技术较Child-Pugh评分能够更全面准确评估原发性肝癌患者肝储备功能,提高肝癌切除手术安全性,具有一定的临床应用价值。更多还原

【Abstract】 Objective: To explore the safety of liver cancer resection with Child-Pugh classification combined with indocyanine green( ICG) R15,Fibroscan and liver 3 D printing technique. Methods: From September 2016 to September 2017,95 patients with primary liver cancer( PLC) underwent resection of liver cancer in our department were selected as the research object. To evaluate by Child-Pugh classification and new classification for their pre-and-post operative hepatic reserve function,and the precision of two classifications to predict hepatic functional compensation were measured. The patients were divided into two groups: the liver 3 D print group and the non-liver 3 D print group. The operative time,bleeding volume,blood transfusion rate and complication rate were compared between the two groups. Results: The precision of Child-Pugh classification to predict postoperative hepatic functional compensation and mild hepatic functional decompensation was 68. 75 % and 64. 52 %,respectively,which were 84. 91 % and84. 21 % for the new classification,respectively. In the liver 3 D print group,the operative time,bleeding volume,blood transfusion rate and complication rate were( 178. 3 ± 88) min,380. 0 m L,27. 87 %( 17/61),32. 78 %( 20/61). In the non-liver 3 D print group,the operative time,bleeding volume,blood transfusion rate and complication rate were( 216. 1 ± 101) min、450. 0 m L、38. 23 %( 13/34) 、41. 18 %( 14/34). There was significant difference between the two groups( P < 0. 05). Conclusion: The new liver reserve assessment system combined with liver 3 D printing technology can be more comprehensive and accurate than Child-Pugh classification in assessment of PLC patients liver reserve function,and can improve the safety of hepatectomy surgery. It has a certain clinical value.更多还原