靛氰綠檢測在臨床上之應用－－術後併發症評估

The Role of Indocyanine Green Test in Estimation of the Post-Hepatectomic Morbidit

在台灣，因為器官捐贈的觀念仍未完全普及，所以除了肝臟移植手術之外，肝臟切除手術仍是治療肝細胞腫瘤的主要方式之一。對於外科醫師來說，如何準確地評估殘存的肝臟機能是非常重要的；這對於即將接受肝臟切除的患者，不僅可以決定是否可以切除及切除範圍大小，而且可以預測術後成效。靛氰綠測試15分鐘滯留率(ICG R15)是目前在術前最常用來評估肝功能的檢驗項目之一，但是其在術後評估所能提供醫師的資訊卻非常有限，無法滿足臨床醫師的需求。本研究共收集了31位在台大醫院接受肝臟切除手術的受試者，評估ICG R15及ICG K的相關性及作為評估術後併發症的價值。研究結果顯示，ICG R15與ICG K有很好的相關性(R2 =0.9047, p<0.001)，可以做為術前評估的工具。此外，ICG R15與術後之併發症沒有顯著相關，而較低的ICG K則與較高的術後腹水發生率與較長的住院天數則有顯著相關(p<0.05)。因此我們建議ICG K是較好的術後併發症評估工具，可以在術前就提供外科醫師醫療決策的可靠建議。

Aim: To investigate the possibility of evaluating post- hepatectomic complication rate by ICG test. Methods: Thirty-one patients (20 men and 11 women) receiving massive hepatectomy in National Taiwan University Hospital were enrolled during October 2007 till June 2008. Preoperative ICG test was performed in all participants, and both ICG R15 and ICG K value were collected to evaluate post-operative complication. Results: A significant correlation between ICG R15 and ICG K (R2 =0.9047, p<0.001) was noted. The complication rate showed no significant relationship to ICG R15, but the incidence of prolonged post-operative ascites accumulation and hospital stay was significantly higher in the patients with lower ICG K value(p<0.05). Discussion: ICG K value may be more useful to provide surgeons the preoperational decision- making information than ICG R15. Moreover, ICG K value showed significant correlation with the complications of post-operation. According to the observations, the calculated ICG K value was assumed to be a good prognostic indicator early after hepatectomy.