摘要目的 比较终末期肝病模型(MELD)评分与Child-Pugh分级两种方法评估肝癌患者肝脏储备功能进行肝切除术风险的应用价值.方法 回顾性分析202例因肝细胞癌行肝切除术患者的临床资料.术前计算MELD评分和Child-Pugh分级,分析两者与术后发生肝功能不全的关系.结果 术后共有90例患者出现术后肝功能不全.Child A级患者发生术后肝功能不全80例(44.0％),Child B级患者发生术后肝功能不全10例(50.0％),Child A级与B级两组患者术后肝功能不全发生率的差异无统计学意义(P＞0.05).MELD评分≤14分者术后发生肝功能不全79例(41.6％),MELD评分＞14分者术后发生肝功能不全11例(91.7％),术前MELD分＞14分与≤14分两组患者术后肝功能不全发生率差异有统计学意义(P＜0.05).MELD＜8分、8≤MELD≤14分、MELD＞ 14分三组患者术后肝功能不全的发生率分别为38.2％、57.6％、91.7％,各组间术后肝功能不全发生率的差异有统计学意义(P＜0.05).Spearman等级相关检验显示MELD评分与Child-Pugh分级密切相关(r=0.404;P ＜0.05).MELD评分、Child-Pugh分级的ROC曲线下面积分别为0.703和0.587(P＜0.05).结论 与Child-Pugh分级比较,MELD评分能更有效地预测肝切除术后肝功能不全的发生情况.术前MELD评分＞14分的患者术后发生肝功能不全的风险较高,须严格把握适应证.需行肝切除手术患者,应积极做好术前治疗,使之达到或小于14分时再行手术.

abstractsObjective To determine the perioperative risks of partial hepatectomy by determining the preoperative liver functional reserve in patients with hepatocellular carcinoma (HCC),and to compare the model for end-stage liver disease (MELD) score with the Child-Pugh classification in predicting prognosis.Methods We reviewed the clinical data of 202 patients with HCC who underwent partial hepatectomy.The MELD score and the Child-Pugh classification were determined preoperatively.Results The incidence of postoperative liver dysfunction happened in 44.0％ of Child A patients,50％ in Child B patients,41.6％in patients with a MELD score below 14,and 91.7％ in patients with a MELD score of ＞ 14.The difference between the rates of postoperative liver dysfunction in patients with a preoperative MELD score above 14 and below 14 was significant (P ＜ 0.05),while that between patients with Child-Pugh A and B was insignificant (P ＞ 0.05).The incidences of postoperative liver dysfunction in patient with a MELD ＜ 8,8 ≤ MELD ≤ 14,MELD ＞ 14 were 38.2％,57.6％ and 91.7％,respectively,indicating that there was a positive co-relationship between the MELD score and the incidences of liver dysfunction.The Spearman rank correlation test showed the MELD score was significant correlated with the Child-Pugh score (r =0.404 ; P ＜ 0.05).The areas under the ROC curves of the MELD score and the Child-Pugh score were 0.703 and 0.587 (P ＜ 0.05).Conclusions The MELD score predicted postoperative liver dysfunction more accurately than the Child-Pugh classification.HCC patients undergoing partial hepatectomy with a preoperative MELD score ＞ 14 had a high perioperative risk.To ensure the safety of partial hepatectomy,HCC patients with a preoperative MELD score ＞ 14 requires active preoperative preparation,bringing the score near to or less than 14.