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不同评分系统评估肝癌患者行肝切除术围术期风险的临床价值 被引量:2

Clinical value of different scoring system on evaluating the risk of perioperative period of hepatectomy in patients with liver cancer
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摘要 目的探讨MELD评分系统和Child-Pugh评分系统评估肝癌患者行肝切除术围术期风险的临床价值。方法回顾性分析2014年3月至2015年2月于本院行肝切除术的122例肝癌患者的临床资料。采用MELD和Child-Pugh评分系统对肝切除术围术期的风险进行评估,比较两种方法对肝功能以及术后并发症的评估价值。结果 MELD评分系统和Child-Pugh评分系统评估患者术后肝功能不全的发生率分别为44.26%和50.00%,差异无统计学意义(χ^2=0.81,P=0.37)。两种评分系统对术后并发症发生率评估的差异有统计学意义(χ^2=4.65,P=0.03),以Child-Pugh评分系统进行评估时,Child-Pugh分级为A级的患者肝功能不全发生率显著低于B级和C级患者(χ^2=7.05、7.03,P=0.01、0.01);Child-Pugh分级为C级的患者术后并发症的发生率显著高于A级和B级患者(χ^2=11.37、6.38,P=0.00、0.00);不同MELD评分分级间肝功能不全和并发症的发生率均有统计学差异(χ^2=34.99、31.97,P=0.00、0.00),MELD评分越高,肝功能不全发生率越高。随着MELD和Child-Pugh评分的升高,并发症的发生率逐渐升高。在肝功能和并发症的评估上,MELD评分系统与Child-Pugh评分系统具有相关性(r=0.56,P=0.03)。结论 MELD和Child-Pugh评分系统均能有效预测术后肝功能,MELD评分系统评估并发症的发生优于Child-Pugh,MELD评分系统对术后肝功能不全发生的预测效果优于Child-Pugh评分系统。 Objective To investigate the value of MELD and Child-Pugh scoring system on the risk of perioperative period of hepatectomy in patients with liver cancer. Methods The clinical data of 122 patients with hepatocellular carcinoma who underwent hepatectomy from March 2014 to February 2015 in our hospital were retrospectively analyzed. MELD and Child-Pugh scoring system were used to assess the risk of perioperative period in hepatectomy and the appraisal values on liver function and postoperative complications were compared. Results The incidence rates of liver dysfunction in perioperative period of hepatectomy in patients with liver cancer which were assessed by MELD and Child-Pugh scoring system were 44.26% and 50.00%, respectively. The difference had no statistical significance(χ^2= 0.81, P = 0.37). The difference of complication rates assessed by the two scoring system were statistically significant(χ^2 = 4.65, P = 0.03). The incidence of hepatic insufficiency in Child-Pugh A grade patients was significantly lower than those of ChildPugh B and C grade patients(χ^2 = 7.05, 7.03; P = 0.01, 0.01), and the incidence of complications in ChildPugh C grade patients was significantly higher than those of Child-Pugh A and B grade patients(χ^2 = 11.37, 6.38; P = 0.00, 0.00). The incidence of liver dysfunction and complications among the four MELD grades had statistical difference(χ^2 = 34.99, 31.97; P = 0.00, 0.00). The rate of liver dysfunction increased with the higher MELD scores and the rate of complications increased with the higher MELD and Child-Pugh scores. The MELD and Child-Pugh scoring system were relevant in the assessment of liver function and complications(r = 0.56, P = 0.03). Conclusion MELD and Child-Pugh scoring system can effectively predict the postoperative liver function and MELD scoring system is better than Child-Pugh scoring system in the assessment of liver function.
作者 周玉庆
出处 《中国肝脏病杂志(电子版)》 CAS 2016年第3期83-86,共4页 Chinese Journal of Liver Diseases:Electronic Version
关键词 终末期肝病模型 CHILD-PUGH 肝切除术 Model for end-stage liver disease Child-Pugh Hepatectomy
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