臨牀消化器内科 Vol.29 No.4(1)


特集名 肝硬変―診断と治療の進歩
題名 肝硬変の診断とステージ分類
発刊年月 2014年 04月
著者 橋本 直明 東京逓信病院消化器内科
著者 光井 洋 東京逓信病院消化器内科
【 要旨 】 肝硬変とは,慢性肝疾患の終着点であり,表面凹凸で,組織学的に小葉構造の改築,偽小葉結節を認める状態である.すなわち,肝硬変とは形態学的な診断名である.肝硬変の診断は,腹腔鏡,肝生検が望ましい.日常的には,病歴,身体所見,採血検査,画像検査などの特徴を総合して推定・診断することも多い.成因,予備能,合併症も含めて診断する.進行に伴い,全身性疾患としての側面が強まる.また肝細胞癌の高リスク群でもある.肝硬変の重症度,予備能の分類には Child-(Turcotte-)Pugh分類が広く使われている.ICGやアシアロシンチによる分類,肝細胞癌合併例ではCLIP score,JIS score,進行例では MELD scoreも有用である.
Theme Cirrhosis -- Recent Progress in Diagnosis and Treatmen
Title Diagnosis and Stage Criteria for Liver Cirrhosis
Author Naoaki Hashimoto Department of Gastroenterology, Tokyo Teishin Hospital
Author Hiroshi Mitsui Department of Gastroenterology, Tokyo Teishin Hospital
[ Summary ] Cirrhosis is an end stage diffuse liver disease caused by many factors. Histologically, cirrhosis is characterized by nodularity and fibrosis, including round nodules surrounded by fiberous septa. Diagnosis of cirrhosis is based on histological findings obtained from biopsy specimens, or on laparoscopic findings of irregular liver surfaces. However, in practical medicine, cirrhosis is usually best determined by a combination of clinical findings, laboratory date, and imaging studies. Etiology, functional reserves, and complications should also be evaluated. With progress of the disease, not only the liver is injured, but also many other parts of the body would be affected. In addition, cirrhosis presentsa high risk of hepatocellular carcinoma (HCC) development. In the cirrhotic liver, precise diagnosis of functional reserves is needed for proper clinical management or treatment of complications. The Child-Pugh score is the most common method to do so. CLIP scores or JIS scores are indicated in cases with HCC. The MELD score is used in most critical cases.
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