肝疾病患者手术风险评估

Evaluation of Surgical Risk of Patients with Liver Disease

最近的研究已确定了肝病患者的疾病手术是否安全的客观标准。用这些标准可以使更多肝病患者行外科手术的风险变小。与非肝病患者相比肝病患者行手术治疗时死亡和肝功能失代偿的风险性增加。除非予以特殊的检查,否则肝疾病在术前常未予明确诊断。肝疾病不排除手术,如仔细筛选,某些手术可安全进行。最近研究提示,Child-Pugh评分为8分和终末肝疾病评分14分是分界线,超过此水平,肝硬化患者行手术的风险性大大增加。患有急性肝炎的患者行手术治疗通常是不明智的,但对于轻度慢性肝炎患者,手术是安全的。

Recent studies have defined the objective criterion to determine the surgical safty for patients with liver disease. We can achieve the smaller risk of surgical therapy for patients with liver diseases by using these criteria. Patients with liver disease will suffer more increased risk of death and liver dysfunction during surgical therapy than that of patients without liver disease. Liver disease should be diagnosed clearly before operation except for some special examinantions. If operation is not ehminated from the method for liver disease therapy,some operation can be carried out safely with careful screening. Recent study suggested that a scoring 8 in Child-Pugh scoring and 14 in Model for End-Stage Liver Disease（MELD） score is dividing line. If the scoring is above this level, the surgical risk will be increased greatly in patients with hepatic cirrhosis. It is unadvisable to carry out operation in patients with acute hepatitis. But surgery is always safty in the patients with chronic hepatietis with slight degree, the patients with liver disease will have more operative risk.