腹腔镜胆囊切除术在肝硬化患者中的应用体会

目的总结肝硬化合并胆囊疾病患者行腹腔镜胆囊切除术的临床经验。方法回顾性分析1995年7月至2008年12月87例伴有肝硬化的胆囊疾病患者行腹腔镜胆囊切除术的临床资料。结果76例成功行腹腔镜下胆囊切除，6例行胆囊次全切除，5例中转开腹。手术时间18～135min，平均47．3min。术中出血15～350ml，平均52．5ml。9例术后出现腹水，无胆道损伤、胆漏、腹腔感染及肝功能衰竭等并发症。术后住院3～15天，平均5．7天。结论经过充分的术前准备，细致的术中操作，恰当的术后处理，肝硬化合并胆囊疾病患者行腹腔镜胆囊切除术是安全的，但对ChildC患者应审慎选择。

Experience of laparoscopic cholecystectomy in patients with hepatic cirrhosis

Objective To summarize the clinical experience of laparoscopic cholecystectomy in pa- tients with hepatic cirrhosis. Methods The clinical data of 87 cases with hepatic cirrhosis was analyzed ret- rospectively. Results Laparoscopic cholecystectomy was completed in 76 cases, 6 cases received subtotal cholecystectomy, and 5 cases converted to open procedure. The operation time was betweenl8 to 135 mi- nutes （ mean was 47.3 minutes）. Blood loss ranged from 15 to 350 ml （ mean, 52.5 ml）. The patients were discharged 3 to 15 days （ mean, 5.7 days） after the operation. 9 cases developed ascites postoperatively. No bile duct injury, abdomen infection, and failure of liver function were founds in all patients. Conclusion Laparoscopic cholecystectomy is safe for patients with hepatic cirrhosis if having enough preoperative prepara- tion, careful intraoperative procedure, and proper postoperative treatment.