Evaluation of Liver Function by Indocyanine Green in Patients with Obstructive Jaundice : Usefullness of Heavy ICG Load Test

  • Kumazawa Ken-ichi
    Department of Surgery, Tokyo Women's Medical College, Daini Hospital
  • Oishi Toshinori
    Department of Surgery, Tokyo Women's Medical College, Daini Hospital
  • Ohigashi Seiji
    Department of Surgery, Tokyo Women's Medical College, Daini Hospital
  • Kubota Koichi
    Department of Surgery, Tokyo Women's Medical College, Daini Hospital
  • Asami Yoshiaki
    Department of Surgery, Tokyo Women's Medical College, Daini Hospital
  • Otani Yoichi
    Department of Surgery, Tokyo Women's Medical College, Daini Hospital
  • Haga Shunsuke
    Department of Surgery, Tokyo Women's Medical College, Daini Hospital
  • Kajiwara Tetsuro
    Department of Surgery, Tokyo Women's Medical College, Daini Hospital

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  • ICG検査からみた閉塞性黄疸患者に対する肝機能の評価 : とくに大量負荷試験の有用性について

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In order to evaluate the indocyanine green(ICG)test for patients with obstructive jaundice, 183 inpatients who had undergone an ICG test during the past 9 years were divided into 105 individuals with liver cirrhosis, 35 with jaundice and 43 without jaundice, and their data were compared. The disappearance rates(K_<0.5>, K_<3.0>)at ICG doses of 0.5 and 3.0mg/kg and the maximum removal rate(Rmax)were obtained, and the correlation between Rmax and each disappearance rate was examined. In the cirrhosis group, Rmax was strongly correlated with both K_<0.5> and K_<3.0>, showing correlation co-efficients of 0.724 and 0.869, respectively. In contrast, in the jaundice and non-jaundice groups, Rmax was strongly correlated with K_<3.0>(0.832, 0.791), but there was a wide variance in the values of K_<0.5>(0.525, 0.524). In addition, the gradient of the regression line for the correlation with K_<0.5> was moderate, 0.392, in the jaundice group, whereas it was 0.799 in the cirrhosis group. Of 26 patients who underwent resection of two or more hepatic segments, 11 had a total bilirubin level of 10mg/dl or higher during surgery. In these 11 patients, Rmax and K_<3.0> were low before surgery, but the properative K_<0.5> varied widely. Thus, Rmax proved to be a superior parameter of the preoperative ICG test for patients with obstructive jaundice. With regard to the disappearance rate, K_<3.0> under a greater load was found to reflect the degree of hepatic reserve more faithfully.

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