Child分级、MELD评分系统在胆囊炎合并肝硬化患者行腹腔镜胆囊切除术中的应用评价  

Evaluated the Child-Turcotte-Pugh classification and MELD score for the prognosis of laparoscopic cholecystectomy in patients with cirrhosis

作　　者：李坤平[1] 方永平[1] 廖锦岐[1] 段进东[1] 袁波[1] 廖方[1] 游锦华[1] 

机构地区：[1]广东省惠州市第一人民医院肝胆外科,516000

出　　处：《中华肝胆外科杂志》2014年第3期170-174,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的通过Child分级、MELD评分了解胆囊炎合并肝硬化患者行腹腔镜胆囊切除术（Lc）术前肝功能状况及预后，评价MELD评分系统临床运用价值。方法收集我院和惠州市中心人民医院2009年1月至2013年6月普外科收治的973例胆囊炎患者资料，其中胆囊炎合并肝硬化373例患者入选，ChildC级、MELD评分〉30分、中转开腹等38例予以剔除。335例患者经Child分级、MELD评分随机分成两组进行回顾性对比分析。结果（1）在术中出血方面，ChildA组[（106±11）ml]和ChildB组[（109±11）ml]，差异无统计学意义（P〉0．05）；而MELD评分中R〈14组[（58±15）ml]显著少于R≥14组[（120±28）ml]（P〈0．01）。（2）术后并发症的比较中，ChildA组（10例，12％）和ChildB组（17例，21％）比较差异无统计学意义（P〉0．05）；MELD评分中R〈14组（10例，12％）少于R≥14组（27例，33％）（P〈0．05），差异有统计学意义。（3）在住院天数方面，ChildA组（9±1）和ChildB组（10±2）差异无统计学意义（P〉0．05）；MELD评分中R〈14组（7±1）少于R≥14组（114-2）差异有统计学意义（P〈0．01）。（4）在住院费用比较中，ChildA组（1．337±0．063）和ChildB组（1．359±0．089）差异无统计学意义（P〉0．05）；MELD评分中R〈14组（1．108±0．123）少于R≥14组（1．568±0．117）差异有统计学意义（P〈0．01）。结论较之Child分级，MELD评分系统更具科学性、客观性。该评分系统更能准确判断术前肝功能情况，有助于预判术中出血量及术后并发症发生率，从而缩短住院天数、减少住院费用。因此，MELD评分系统对胆囊炎合并肝硬化患者临床治疗具有客观指导意义。Objective To evaluate the preoperative liver function and prognosis of laparoscopic cholecystectomy （LC） in patients with cirrhosis, using the Child-Tureotte-Pugh classification and the model for end-stage liver disease（MELD） score. Methods From January 2009 to June 2013, 973 patients who were admitted to the Department of General Surgery of our hospital and the HuiZhou Municipal Central Hosptial were studied. Of the 373 patients with cirrhosis, 38 patients were excluded because of Child C, MELD 〉 30, or laparotomy. The remaining 335 patients who received laparoscopic cholecysteetomy were randomly divided into two groups The Child grade and MELD score were retrospectively analyzed. Results There was no significant difference in intraoperative hemorrhage between the Child A group [ （106 ± 11 ） ml] and the Child B group [ （ 109 ± 11 ） ml ] （P 〉 0.05）. The R 〈 14 scores in the MELD group [ （58 ± 15 ） ml ] was significantly lower than that in the R ≥ 14 group [ （120 ± 28 ） ml ] （P 〈 0. 01 ）. There was no significant difference in postoperative complications between the Child group A （10 cases, 12% ） and the Child group B （ 17 cases, 21% ） （ P 〉 0.05 ）. There was a significantly lower incidence in the R 〈 14 scores in the MELD group （ 10 cases, 12% ） than the R≥ 14 group （27 cases, 33% ） （ P 〈 0.05 ）. There was also no significant difference in the hospital stay between the Child A group （9 ± 1 ） and the Child B group （ 10± 2） （P〉0.05） ; the R 〈 14 score of the MELD group （7 ± 1） was significantly less than that of the R≥14 group （11 ± 2） （P 〈 0. 01 ）. There was no significant difference in the cost of hospitalization between the Child A group （ 1. 337 ± 0. 063 ） and the Child B group （ 1. 359±0. 089 ） （ P 〉 0. 05 ） ; the R 〈 14 group （MELD score 1. 108 ± 0. 123 ） was significantly less than that of the R ≥ 14 group （1. 568 ± 0. 117 ） （ P 〈 0.01 ）. Con^lttsion Compared w

关 键 词：胆囊炎 肝硬化 腹腔镜胆囊切除术 CHILD分级 MELD评分系统 

分 类 号：R657.41[医药卫生—外科学] R657.31[医药卫生—临床医学]