D-山梨醇清除率法评估肝储备功能

目的探讨D-山梨醇肝脏清除率(CLh-s)法补充吲哚箐绿15min潴留率(ICGR15)和Child-Pugh分级相结合评估肝硬化门脉高压患者肝储备功能的可行性。方法41名肝硬化门脉高压患者分别给予Child-Pugh分级、ICGR15、CLh-s检测评估肝储备功能,对前两种评估方法出现交叉重叠的患者,进一步分析其CLh-s值与手术并发症的相关性。结果Child-Pugh分级与ICGR15值(以40%为界)交错重叠主要集中在B级和C级之间。在Child-Pugh分级B级的18例患者中,>40%的患者有5例,术后3例出现明显并发症(CLh-s分别为629.52、509.79、450.71 mL/min),2例未出现明显并发症(CLh-s分别为784.49、779.36 mL/min);在Child-Pugh分级C级的13例患者中,有4例ICGR15<40%的患者,2例行手术治疗,其中1例出现并发症(CLh-s为484.57 mL/min)。1例未出现明显并发症(CLh-s为723.36 mL/min)。概括之,CLh-s>700 mL/min者,手术并发症少;CLh-s<700 mL/min,者手术并发症多。结论CLh-s与肝硬化门脉高压患者手术并发症有关。该法可对ICGR15和Child-Pugh分级联合评估肝储备功能时出现交叉重叠者进一步分类,使肝储备功能评估更为准确可靠。

Evaluation of liver functional reserve by clearance of D-sorbitol

Objective To study the feasibility of evaluating hepatic functional reserve by hepatic clearance of D-sorbitol making up ICGR15 and Child-Pugh classification.Methods The retention rate of indocyaninegreen at 15 min(ICGR15),Child-Pugh classification and hepatic clearance of D-sorbitol(CLh-s) were examined in 41 patients with liver cirrhosis.Relation of CLh-s with operation complication was given a further study when ICG R15 and Child-Pugh classification was crossed.Results The cross of ICGR15(40% being boundary) and Child-Pugh classfiction was centralized between Child-Pugh B and Child-Pugh C.ICGR15 of 5 cases were higher than 40% in 18 ones of Child-Pugh B.Three of them had complications(CLh-s: 629.52 mL/min,509.79 mL/min,450.71mL/min),While two of them had no complications(CLh-s: 784.49 mL/min,779.36 mL/min).ICGR15 of 4 cases was lower than 40% in 13 cases of Child-Pugh C.One case of the two operated ones had complications(CLh-s: 484.57 mL/min),While another one had no complications(CLh-s: 723.36 mL/min).In general,complications were few when CLh-s of the patients with liver cirrhosis was low(≤700 mL/min),in cross between ICGR15 and Child-Pugh classification,while operation complications were more when CLh-s was high(>700 mL/min).Conclusion The CLh-s could be correlated with operation complications,and be considered as an effective supplement to evaluate hepatic functional reserve when combined with ICGR15 and Child-Pugh classification. It could be used to evaluate liver functional reserve more effectively and reliably.