肝硬化患者行腹腔镜胆囊切除术的风险评估

目的：总结肝硬化患者行腹腔镜胆囊切除术可能存在的风险。方法：对我院自2000年3月至2006年10月完成的53例肝硬化患者的腹腔镜胆囊切除术的临床资料进行回顾性分析并对术中遇到的困难进行分类。结果：53例患者均安全完成手术,无一例死亡。1例因胆囊三角出血中转开腹。71.1%的病例有网膜和肝脏与胆囊的广泛粘连,43.3%的病例因肝脏牵引困难而在右上腹增加了戳孔,使用多叶拉钩牵开肝脏。20.3%的病例因胆囊三角暴露困难而采取了逆行胆囊切除术。18.9%的病例因胆囊床剥离困难或肝门、胆囊三角解剖困难而采用了不同类型的胆囊次全切除术。平均手术时间较普通人群延长28min。平均住院时间较普通人群延长1d。结论：肝硬化患者腹腔镜胆囊切除术存在粘连和新生血管生成、肝脏牵引较为困难、胆囊三角暴露不充分、处理胆囊床风险较高、肝门结构分辨和分离困难等5类问题。但同时也有开腹手术不具备的优势。

Risk evacuation about laparoscopic cholecystectomy in cirrhosis patients

Objective:To summarize the potential risk about laparoscopic cholecystectomy in cirrhosis patients.Methods:A retrospective review was performed in 53 patients underwent laparoscopic cholecystectomy from Mar.2000 to Oct.2006,The difficulties encountered in operative process was classcfied.Results:53 cases were safely and effectively performed.There was no mortality.1 patient underwent conversion because of hemorrhage in Calot's triangle.Omental adhesion to gallbladder or liver surface existed in 71.1% patients.43.3% patients added a right hypochondriac region port because the liver was hard to be tracted.20.3%patients were adopted the fundus first method because of the difficulty of exposing the cholecystohepatic triangle.18.9% cases were adopted different type of subtotal cholecystectomy because it hard to separated gallbladder from gallbladder bed or dissect the liver hilum.The mean operation time was 28 minutes longer than ordinary cases.The meantime stay in hospital was longer 1 day than ordinary cases.Conclusions:Laparoscopic cholecystectomy in liver cirrhosis patients follow several risky factors.Include:Adhesion and neovascularity,difficulty traction on the liver,inadequate exposure of the cholecystohepatic triangle,high risk of disposaling gallbladder bed and difficulty of separating and discerning hepatic hilum.But at the same time LC can also has its unique advantages.