终末期肝病模型在肝癌破裂出血急诊术前评估中的应用

目的探讨终末期肝病模型（MELD）评估肝储备功能在原发性肝癌破裂出血中确定急诊手术适应证的应用价值。方法2002年1月至2005年4月间在传统的手术适应证标准的基础上联合MELD评估后，急诊肝切除治疗肝癌破裂出血18例。结果全部病例MELD分值〈18，均值为（13.3±4．2）分。18例患者均顺利完成手术，无围手术期死亡。15例获得随访，生存时间为4～51个月。1、3年生存率分别为66．7％（10／15）、33．3％（5／15）。结论在经过临床选择的病例中，急诊肝切除治疗原发性肝癌破裂出血是安全可行的，疗效显著。MELD评分简单，能够客观地反映肝储备功能，对原发性肝癌破裂出血确定合理的治疗方案有重要的参考价值。

Clinical value of MELD in emergency preoperation of spontaneous rupture of primary hepatocellular carcinoma

Objective To assess the application of model for end-stage liver disease （MELD） to estimate the hepatic functional reserve in patients with spontaneous rupture of primary hepatocellular carcinoma in order to indicate for emergency surgery. Methods From January 2002 to april 2005, eighteen cases with spontaneous rupture of primary hepatocellular carcinoma, who underwent curative emergency hepatectomy were retrospectively analyzed. Preoperative assessment of hepatic reserve function was carried out by MELD, and other criteria for conventional hepatic resection were all confirmed. Results Of all the cases, the score of MELD was lower than 18（mean= 13.3 ± 4.2）. No operation death occurred in all of 18 cases, of which 15 cases were followed up. The survival time was 4-51 months, and the overall 1-year and 3-year survival rates were 66.7%（10/15） and 33.3%（5/15） respectively. Conclusions Emergency hepatectomy is a safe and feasible approach for selecting optimal treatment in patients with spontaneous rupture of primary hepatocellular carcinoma. MELD may be useful for determining the hepatic reserve function with its simple, rapid and sensitive characters, playing an important role in identifying therapeutic procedure for spontaneous rupture of primary hepatocellular carcinoma.