危重症肝病肝移植患者诊断和评估标准的临床进展
Clinical progress of diagnostic and evaluation criteria for liver transplantation in patients with severe liver disease
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摘要: 肝移植是危重症肝病唯一有效的根治手段, 但手术风险高, 围手术期病死率高, 术后并发症高。考虑到供肝短缺及相关手术风险, 需要严格掌握手术指征和移植时机。因此对危重症肝病肝移植的患者进行准确诊断和全面评估病情, 是决定治疗方案的一项重要内容。目前对于危重症肝病的评估标准很多, 除了比较经典的Child-Turcotte-Pugh(CTP)评分和终末期肝病模型(MELD)评分外, 还发展出了许多其它评估标准, 各个移植中心也都有自己的选择, 但并没有一个较为统一的诊断标准, 各评估标准之间也存在争议, 本文即对此进行综述。Abstract: Liver transplantation, although recognized as the only effective radical treatment for severe liver disease, might be accompanied by high surgical risks, high perioperative mortality and high postoperative complications. Considering the shortage of donor liver and related surgical risks, it is necessary to strictly control the indication of operation and the opportunity of transplantation. Therefore, accurate diagnosis and comprehensive evaluation of the condition of patients with severe liver disease to be treated by liver transplantation is an important part in determining the treatment plan. At present, there are many evaluation criteria for severe liver disease. In addition to the classic ChildTurcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score, many other evaluation criteria have also been developed. All transplant centers have their own choices and thus there is no uniform diagnostic criterion, with disputes among various criteria, which is exactly what this paper aims to summarize.