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一、终末期肝病的危险度评分模型的由来 近年来,经颈静脉肝内门体分流术(Transjugular intra-hepatic portosystemic shunts,TIPS)广泛用于治疗门静脉高压的并发症,如控制食管胃底曲张静脉破裂出血、预防曲张静脉再出血、治疗顽固性腹水等。但急诊TIPS术后,患者病死率很高;并发现某些因素如肝病进展程度、高胆红素血症等与患者的预后有关。于是,有些学者试图寻找一种能够准确预测TIPS术后患者的生存率的模型。 目前绝大多数学者采用Child和Turcotte于1964年提出的Child-Turcotte分级及1972年Pugh对其修改而形成的Child-Push分级,以评价肝硬化患者肝功能储备、手术风险以及预后。但是,这两种分级在预测TIPS术后患者生存率方面存在一系列局限性。首先,大多数行TIPS的患者Child-Pugh分级为C级,因此,Child-Pugh分级无法进一步区分这些患者;其次Child-
First, the risk of end-stage liver disease score model origin In recent years, transjugular intra-hepatic portosystemic shunts (Transjugular intra-hepatic portosystemic shunts, TIPS) is widely used in the treatment of complications of portal hypertension, such as the control of esophageal and gastric varices Bleeding rupture of the vein, prevention of variceal bleeding, treatment of intractable ascites and so on. However, emergency TIPS postoperative patients with high mortality; and found that some factors such as the degree of progress of liver disease, hyperbilirubinemia and prognosis of patients. As a result, some scholars have sought to find a model that accurately predicts the survival of patients after TIPS. At present, most scholars use the Child-Turcotte classification proposed by Child and Turcotte in 1964 and the Child-Push classification modified by Pugh in 1972 to evaluate the liver function reserve, surgical risk and prognosis in patients with cirrhosis. However, these two grading have a number of limitations in predicting patient survival after TIPS. First, most patients with TIPS had Child-Pugh grade C, and therefore, Child-Pugh classification failed to further differentiate these patients. Second, Child-