肝硬化患者腹腔镜胆囊切除术212例临床分析

Laparoscopic cholecystectomy for patients with cirrhosis：an analysis of 212 cases

关键词:  肝硬化；腹腔镜；胆囊炎  胆石症

Key words:  cirrhosis  laparoscope  cholecystitis  cholelithiasis

摘要:

[目的] 探讨肝硬化患者行腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）的可行性。[方法] 对1994年2月—2011年2月期间行LC治疗的合并肝硬化的症状性胆囊结石患者212例临床资料进行回顾性分析, 总结肝功能Child A级（n=180）、B级（n=32）肝硬化患者围手术期处理与手术中注意事项。[结果] 212例中仅9例中转开腹, 中转率4.24%,术后并发症包括腹水、胆管损伤、肺炎，经保守治疗后均治愈, 无死亡及肝功能衰竭等严重并发症发生。肝功Child分级不同，手术时间、住院时间、术中出血、中转开腹率及并发症发生率亦不同。Child A级疗效明显优于B级（P<0.05）。[结论] 处于Child A 级或Child B级的肝硬化患者行腹腔镜胆囊切除术是安全可行的, 丰富的腹腔镜手术经验和完善的围手术期处理是手术成功的关键。

Abstract:

[Objective] To evaluate experience with laparoscopic cholecystectomy in patients with cirrhosis and to provide recommendations for management. [Methods] Retrospective review of laparoscopic cholecystectomy in 212 cases patients with cirrhosis from Feb, 1994 to Feb, 2008 in our team was performed. Peri-operative characteristics and subgroup analysis were performed in patients with Child Pugh's classes A, B cirrhosis. [Results] Of the nine patients (4.24%) that were converted to an open cholecystectomy in this study. Postoperative main complications are ascites, biliary duct injury and pneumonia. No mortality and no liver function failure occur in the study. Compared with patients with Child's class B, laparoscopic cholecystectomy in patients with Child's class A was associated with significantly decreased operative time, short of hospital stay，less blood loss, lower conversion to open cholecystectomy and complications（P<0.05）. [Conclusions] Laparoscopic cholecystectomy in patients with Child's class A and B is feasible with no mortality and low morbidity.and appropriate preoperative preparations and careful intraoperative techniques are required for better outcomes.