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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

作者：周玉庆

单位：重庆市急救中心肝胆外科重庆 400010

关键词：终末期肝病模型 Child-Pugh 肝切除术

分类号：

出版年,卷(期):页码：2016,8(3):83-86

摘要：

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。

Abstract: 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 Child-
Pugh B and C grade patients (χ 2 = 7.05, 7.03; P = 0.01, 0.01), and the incidence of complications in Child-
Pugh 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.

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