肝硬化门脉高压症患者行腹腔镜胆囊切除术的临床体会(附128例报告)

目的:探讨为肝硬化门脉高压症患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性及临床效果。总结肝功能Child A、B级肝硬化患者围手术期处理及术中注意事项。方法:回顾分析2000年1月至2011年1月为128例合并肝硬化门脉高压症的胆囊结石患者行LC的临床资料,其中Child A级95例(A组),Child B级33例(B组)。结果:A组手术时间平均(31.6±12.5)min,平均住院(4.3±1.5)d;B组手术时间平均(61.6±24.5)min,平均住院(6.3±1.8)d。A组无一例中转开腹及术后并发症发生;B组3例(2.34%)中转开腹,术中胆管壁电刀灼伤1例,术后出现腹水5例、肺炎3例。结论:为Child A、B级的肝硬化门脉高压症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及完善的围手术期处理是手术成功的关键。

Laparoscopic cholecystectomy for patients with cirrhotic portal hypertention: with a report of 128 cases

Objective：To evaluate experience on laparoscopic cholecystectomy in patients with cirrhotic portal hypertention and to provide recommendations for management.Methods：Retrospective review of laparoscopic cholecystectomy in 128 patients with cirrhotic portal hypertention from Jan.2000 to Jan.2011 in us team was performed.Patients with Child-Pugh＇s classes A（n=95） were drawn into Group A,while the patients of Child-Pugh＇s classes B（n=33） were drawn into Group B.The perioperative management and intraoperative matters needing attention were discussed.Results：The mean operation duration and hospital stay of Group A were（31.6±12.5） min and（4.3±1.5） d,while those of Group B were（61.6±24.5） min and（6.3±1.8） d.No conversion nor complications occurred in Group A,3 cases of conversion,1 case of bile duct injury,5 cases of ascite and 3 cases of pneumonia occurred in Group B.Conclusions：Laparoscopic cholecystectomy in patients with Child＇s class A and B is feasible with no mortality and low morbidity.Appropriate preoperative preparations and careful intraoperative techniques are required for better outcomes.