- 期刊
以Indocyanine Green測定肝分葉功能及其對肝臟切除安全性決定之應用
Evaluation of Segmental Liver Function Using Indocyanine Green and Its Application in the Determination for Safety of Hepatic Resection
摘要
肝癌在臺灣是一個極大的問題，許多肝癌患者合併有肝硬化，對這種病人如做肝大範圍之切除，會有肝衰竭之虞，故術前決定各肝葉之機能及肝切除之安全界限極為重要；傳統上，用BSP來測定肝機能，本研究則採用ICG (indocyanine green)，因ICG有許多BSP (bromsulfophthalein) 所沒有的優點。 在靜注0.5mg/kg之ICG後，可測得各段時間ICG濃度，從而測出ICG之15分鍾持留率(R15)及消失常數(K)，此即全肝功能之測定。以導管分別插入左右肝靜脈，可測得左右肝葉分別之抽取率，此即肝分葉功能。由全肝及肝分葉功能以及肝體積可預估術後所剩肝之功能，以決定是否能施行手術。自1982年7月至1984年6月，我們共做了34位病人之全肝功能檢查，其中11位另做了肝葉功能，而這11位中，有兩位病人因此檢查認為切除安全而做切除，術後亦很順利，其餘病人則因測知肝儲存能不好，未做切除手術，改以其他方式治療，亦均未發生肝衰竭，本研究結果證實ICG測試可做為肝切除安全上限之指標。
並列摘要
In Taiwan, hepatoma is a big problem. Most of the patients are associated with cirrhosis of liver. The risk of post-operative hepatic failure is rather high in extensive hepatectomy. Therefore, determining the segmental liver function and the safery limits of hepatectomy are important. Traditionally, BSP was used for determining the liver function. We, instead, used indocyanine green (ICG), which is superior to BSP in many aspects, especially the accuracy. After intravenous injection of ICG with dosage of 0.5 mg/kg, the plasma ICG Concentration could be determined at various interval, with which extraction rate of ICG at 15th minute (ICG R15) and disapperance rate constant (ICG K) could then be calculated, that is systemic liver function. Through right and left hepatic veins catheterization, the extraction rates of right and left lobes of the liver could mental liver function and liver volume (by computerized tomographic mapping), the function of remnant liver could be predicted. Whether the patient should be operated on can be decided by these data. From July 1982 to June 1984, there were 34 patients receiving systemic liver function test. Segmental liver function test was also performed in 11 patients. By the ICG criteria, two out of the 11 patients underwent hepatic resection and had smooth post-operative course. The remaining patients were deemed to be ”poor liver reserve”, and received conservative treatments, e.g. transcatheter arterial embolization. No immediate hepatic failure occurred either. Therefore, the method we used by ICG is good for determining the safety limits of liver resection.