CONCLUSION

In this study, we proposed the K-equation, which can calculate HVPG using ICG-R15, platelet count, serum albumin level, serum total bilirubin level, and PT-INR. cHVPG makes it possible to predict postoperative complications and mortality more safely, easily and precisely. In addition, it enables us to choose appropriate treatment modalities for liver surgery candidates.

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21 - 국문요약 -

간수술에 있어 혈청학적 간기능 검사를 통한 문맥압의 평가

아주대학교 대학원의학과 김 태 규

(지도교수 : 김 봉 완)

수술 전 문맥압을 평가하는 것은 간암 수술에 있어 안전한 간절제술을 결정하

는 중요한 요소이다. 안전한 간절제술을 결정하는 기준은 Hepatic venous pressure gradient (HVPG) 10mmHg이다. 하지만 이 방식은 측정시 발생할 수 있는 부작용이 있으며, 동양에서는 드물게 사용된다. 현 연구는 2가지 목적을 지니고 있다. 혈청 학적 검사를 통해 calculated HVPG (cHVPG)를 결정하고, 간기능이 제한적인 환자 에서 cHVPG의 임상적 유용성을 평가하는 것이다. 2006년부터 2008년까지 총 171 명이 본원에서 간 수술을 시행받았으며, 171명 전원은 수술 시행 전에 HVPG, dye-retention test (ICG-R15) 및 혈청학적 검사를 시행받았다. HVPG는 ICG-R15, platelet count, serum albumin 및 prothrombin time (PT-INR)과 다항분석에서 통계적으 로 유의미한 상관관계를 보였다. 선형회귀분석을 이용하여 cHVPG를 계산하여 다음과 같은 식을 도출하였다. cHVPG (mmHg) = 0.209 × ICG-R15 (%) − 1.646 × Albumin (g/dL) − 0.01 × Platelet counts (10³) + 1.669 × PT-INR + 8.911 (Adj.R²=0.707) 이 후 2008년부터 2013년까지 본원에서 간암으로 수술 가능성을 평가 받은 510명에

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게 cHVPG를 적용하여 임상적 유용성을 평가하였다. 510명 중 ICG-R15이 20%가 넘지만 cHVPG가 10mmHg 미만인 68명에서 간절제술을 시행하였고, 환자들은 간 절제술 후 간부전 등의 주요 합병증 없이 회복하였다. 결과적으로 HVPG는 혈청 학적 검사인 ICG-R15, platelet count, serum albumin, PT-INR을 통해 계산할 수 있으 며, cHVPG는 간수술의 방법을 결정하는 데에 있어 HVPG를 대체할 수 있는 유 용한 방법이다.

핵심어: Hepatic venous pressure gradient, Liver function tests, Portal hypertension,

Hepatocellular carcinoma, Hepatectomy