Cucchetti Alessandro, Ercolani Giorgio, Cescon Matteo, Ravaioli Matteo, Zanello Matteo, Del Gaudio Massimo, Lauro Augusto, Vivarelli Marco, Grazi Gian Luca, Pinna Antonio Daniele
Department of Surgery and Transplantation, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.
J Am Coll Surg. 2006 Nov;203(5):670-6. doi: 10.1016/j.jamcollsurg.2006.06.018. Epub 2006 Aug 17.
Hepatectomy for hepatocellular carcinoma in cirrhosis is followed by an impairment of liver function that can lead to patient death. The model for end-stage liver disease (MELD) is considered an index of hepatic functional reserve, and its assessment on postoperative course may properly identify individuals at risk of liver failure.
Two hundred hepatectomies for hepatocellular carcinoma in cirrhosis were reviewed. Irreversible postoperative liver failure was defined as an impairment of liver function after hepatectomy that led to patient death or required transplantation. The MELD scores at postoperative days (POD) 1, 3, 5, and 7 were calculated and kinetics of changes investigated with t-test; logistic regression was applied to identify predictive variables of postoperative liver failure.
Kinetics of postoperative MELD score showed an impairment of liver function between PODs 1 and 3; 185 patients in whom postoperative liver failure did not develop showed a considerable decrease in MELD score between PODs 3 and 5 (11.9+/-2.8 and 10.6+/-2.4, respectively, p<0.001). On the contrary, 15 patients, who experienced the event, showed an increase in MELD score between PODs 3 and 5 (18.2+/-3.9 and 18.3+/-3.6, respectively; p=0.845). Multivariate analysis showed preoperative MELD score (p<0.001), major hepatectomy (p=0.028), and MELD score increase between PODs 3 and 5 (p=0.011) as independent predictors of irreversible postoperative liver failure. Scores are reported as mean+/-SD.
Recovery from liver impairment after hepatectomy for hepatocellular carcinoma in cirrhosis starts from POD 3; MELD scores increasing between PODs 3 and 5 may identify patients at risk of liver failure and represents the trigger for beginning intensive treatment or evaluating salvage transplantation.
肝硬化患者肝细胞癌肝切除术后会出现肝功能损害，这可能导致患者死亡。终末期肝病模型（MELD）被视为肝功能储备指标，对其术后病程进行评估可恰当识别有肝衰竭风险的个体。
回顾了200例肝硬化患者肝细胞癌肝切除术。不可逆性术后肝衰竭定义为肝切除术后导致患者死亡或需要进行移植的肝功能损害。计算术后第1、3、5和7天的MELD评分，并采用t检验研究变化动力学；应用逻辑回归确定术后肝衰竭的预测变量。
术后MELD评分的动力学显示术后第1天和第3天之间肝功能受损；185例未发生术后肝衰竭的患者术后第3天和第5天之间MELD评分显著下降（分别为11.9±2.8和10.6±2.4，p<0.001）。相反，15例发生该事件的患者术后第3天和第5天之间MELD评分升高（分别为18.2±3.9和18.3±3.6；p=0.845）。多因素分析显示术前MELD评分（p<0.001）、肝大部切除术（p=0.028）以及术后第3天和第5天之间MELD评分升高（p=0.011）是不可逆性术后肝衰竭的独立预测因素。评分以均值±标准差表示。
肝硬化患者肝细胞癌肝切除术后肝功能损害的恢复从术后第3天开始；术后第3天和第5天之间MELD评分升高可能识别有肝衰竭风险的患者，是开始强化治疗或评估挽救性移植的触发因素。
