终末期肝病模型评分在梗阻性黄疸外科治疗中的意义

Significance of the MELD scoring system in surgical treatment of obstructive jaundice

目的 前瞻性探究终末期肝病模型（MELD）评分在梗阻性黄疸外科治疗中的临床意义.方法 选择我院2009年1月至2013年12月收治的梗阻性黄疸患者112例,分为A组（Ⅰ期行PTCD术,Ⅱ期行开腹手术,n=53）和B组（直接开腹手术,n=59）;比较两组术中出血量、手术时间、术后并发症、住院时间、病死率和肝功能指标变化.结果 两组患者开腹术后肝功能指标相同时间点比较,差异均有统计学意义（P＜0.05）,且A组患者较B组患者肝功能各项指标恢复较快.MELD＜10分的患者A组较B组住院时间长;MELD≥10分的A组患者术中出血量、手术时间、术后并发症及住院时间均少于B组（P＜0.05）;B组MELD≥20分的患者有3例术后死亡.结论 对梗阻性黄疸患者MELD评分大于10分,特别是大于等于20分时,应先行PTCD解除胆道梗阻,待肝功能改善后再行Ⅱ期手术.这样能少出血量、手术时间、术后并发症,缩短住院时间.MELD评分对评估梗阻性黄疸手术风险具有重要的临床意义.

Objective To prospectively study the clinical significance of the MELD scoring system in surgical treatment of obstructive jaundice.Methods 112 patients with obstructive jaundice who were admitted into our hospital from January 2009 to December 2013 were divided into two groups：group A （Stage Ⅰ PTCD and stage Ⅱ open operation,n =53） and group B （1 stage open surgery,n =59）.The amount of intraoperative bleeding blood loss,operation time,postoperative complications,duration of hospitalization,mortality rate,and the changes in liver function after surgery were compared between the two groups.Results The differences in the liver function index of the two groups on the same postoperative date were significantly different （P 〈 0.05）.The liver function of group A recovered faster than group B.Patients in group A with a MELD 〈 10 points stayed in hospital significantly longer when compared with patients in group B.For patients in group A with MELD 〉 10 points,the operation time,bleeding volume,postoperative complications and hospitalization were significantly less than the patients in group B （P 〈 0.05）.There were 3 patients （group B） who died with MELD ≥ 20 points after operation.Conclusions In patients with obstructive jaundice with a MELD score greater than 10 points,especially those with a score equal to or greater than 20,PTCD should be performed first to relieve biliary tract obstruction,followed by a stage Ⅱ open surgical operation after the liver function had improved.MELD had important clinical significance in the evaluation of operation risk in patients with obstructive jaundice.