术中ICG R15评估肝切除预留肝功能的临床价值与研究进展

Clinical value and research advances of intraoperative ICG R15 assessment for future liver remnant function in hepatectomy

  • 摘要: 肝切除术是治疗肝脏恶性肿瘤的核心手段,但术后肝功能衰竭(PHLF)仍是导致患者围手术期死亡和影响远期预后的主要并发症。随着肝切除术适应证扩大和复杂肝切除术增加,精准评估预留肝功能已成为预防PHLF的关键。传统肝功能评估方法如Child‑Pugh评分、吲哚菁绿清除试验等多聚焦于整体肝功能,难以反映预留肝脏的功能状态。近年来,功能性影像学评估和术中实时功能定量试验,在预留肝功能评估中展现出重要价值。特别是术中吲哚菁绿清除试验,通过模拟术后血流状态,能够更准确地预测PHLF风险,为手术决策提供实时功能依据。笔者系统阐述预留肝功能评估的现状与进展,重点讨论术中吲哚菁绿15 min滞留率在肝切除术中的应用价值及其对PHLF的预测能力,旨在为临床提供更为精准的肝功能评估策略,降低术后并发症发生率,改善患者预后。

     

    Abstract: Hepatectomy remains the cornerstone of treatment for liver malignancies. However, posthepatectomy liver failure (PHLF) continues to be a major cause of perioperative mortality and significantly impacts long‑term prognosis. With the expansion of indications for hepatectomy and the increasing performance of complex liver resections, accurate assessment of the future liver remnant (FLR) function has become crucial for preventing PHLF. Traditional liver function assessment methods, such as the Child‑Pugh score and the indocyanine green (ICG) clearance test, primarily focus on global liver function and struggle to accurately reflect the functional status of the FLR. In recent years, functional imaging modalities and intraoperative real‑time quantitative function tests have demonstrated significant value in evaluating FLR function. Specifically, the intraoperative ICG clearance test, by simulating postoperative hemodynamic conditions, can more accurately predict the risk of PHLF and provide real‑time functional guidance for surgical decision‑making. The authors systematically review the current status and advancements in FLR function assessment, focusing on the application value of intraoperative ICG‑R15 in hepatectomy and its predictive capacity for PHLF. The aim is to provide a more precise strategy for clinical liver function evaluation, ultimately reducing postoperative complication rates and improving patient outcomes.

     

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