摘要
目的 探讨将传统的肝储备功能Child-Pugh（C-P）分级方法指标体系与CT肝硬化分级和CT保留肝容积率相结合,形成新的肝储备功能评估方法（改良C-P分级）,在评估肝癌介入患者肝储备功能中的价值.方法 对60例行肝动脉化疗栓塞术（TACE）的原发性肝癌患者开展前瞻性研究.分别于术前和术后以C-P与改良C-P评分系统评估肝储备功能,了解两种方法预测术后肝功能代偿情况的符合率及生存时间.结果 C-P分级法和改良C-P分级法预测术后肝功能代偿良好符合率分别为64.7%和85.7%（P ＜ 0.05）;C-P分级法和改良C-P分级法预测术后肝功能代偿轻度不良符合率分别为55.6%和83.3%（P ＜ 0.05）;C-P分级法和改良C-P分级法预测术后肝功能代偿重度不良符合率分别为28.6%和66.7%（P ＜ 0.01）.C-P分级法A、B、C级患者中位生存时间分别为62、38和5.2个月,改良C-P分级法1、2、3级患者中位生存时间分别为71、46和7.6个月,两组间生存时间差异显著,有统计学意义（χ2值分别为11.2、8.7、13.5,P ＜ 0.0001）.结论 改良C-P分级系统较C-P评分能够更全面评价肝癌介入患者围手术期肝储备功能.
Objective To determine the value of clinical and CT assessment of hepatic reserve function in patients with cirrhosis and liver cancer undergoing transcatheter arterial chemoembolization （TACE）. Methods Sixty consecutive patients with cirrhosis and primary liver cancer treated using TACE were studied prospectively. The hepatic reserve function was evaluated using Child-Pugh classification and modified Child-Pugh classification before and after TACE respectively. The modified Child-Pugh classification was an integration of Child-Pugh classification, morphological evaluation of the cirrhotic liver and measurement of tumor-free liver volume by CT. Agreement rates of the two methods for assessing the hepatic reserve function peri-operatively and the survival time were calculated. Results The agreement rates of Child-Pugh classification and modified Child-Pugh classification for assessing the postoperative hepatic reserve function were 55.6% and 83.3% respectively in wen-compensated cases （P〈0. 05 ）, 55.6% and 83.3% respectively in mildly decompensated cases （ P〈0.05 ）, and 28.6% and 66.7% respectively in markedly decompensated cases （P〈0.01 ）. The median survival time of patients in Child-Pugh classes A （6：2 months）, B （38 months） and C （5.2 months） was not significantly （x^2= 11.2, 8.7, 13.5, P〈 0.001） shorter than that of patients in modified Child-Pugh classes A （71 months）, B （46 months） and C （7.6 months）. Conclusion Modified Child-Pugh classification is better than Child-Pugh classification for assessing the hepatic reserve function in patients with cirrhosis and liver cancer undergoing TACE.
出处
《影像诊断与介入放射学》
2011年第3期190-193,共4页
Diagnostic Imaging & Interventional Radiology
基金
海南省自然科学基金资助(30527)
