肝硬化患者行腹腔镜胆囊切除术(附68例报告)

目的:总结肝硬化患者行腹腔镜胆囊切除术(LC)的临床经验。方法:回顾分析68例肝硬化患者LC的资料。结果: 68例均获成功,无中转开腹。其中2例胆漏, 1例为胆管撕裂伤,另1例为迷走胆管漏,均在加强引流、抗感染、保肝护肝等保守治疗14d后自行愈合;另有2例胆囊窝积液经保守治疗10d后完全吸收; 1例合并胰腺炎,保守治疗3w后痊愈。术后无腹腔及消化道出血;无肝功衰竭者;无并发血栓形成者;肝功及凝血机制各项指标能在5 -9d恢复至术前水平。结论:正确选择手术时机和准确把握肝硬化者的肝功能储备与Child- Push分级,肝硬化患者需行胆囊切除术时应首选LC术式。

Laparoscopic cholecystectomy combined with cirrhosis: with a report of 68 cases

Objective: To summarize the clinical experience of laparoscopic cholecystectomy (LC) combined with cirrhosis.Methods:Combined with liver cirrhosis, the clinical data of 68 cases wewe retrospectively analyzed. Results:All of 68 cases acomplished in performing LC,without converting to laparotomy. There were two cases that leaked bile,one case was split of biliary duct,another was leak of aberrant bile,both cases were cured by the conservative treatment after 14 days.There were 2 cases which depositted liquid in the bed of gallbladder.The two cases were cured after 10 days. There was one case combined with pancreatitis which has been cured by conservative treatment after 3 weeks.There was no bleeding after each LC,which include bleeding of abdominal cavity and upper digestive tube.There was no failure of liver function,no clot took shape.Each index of liver function reinstated normal as before surgery by 59 days. Conclusions:Precisely master the storage of liver function of each case that combined with cirrhosis and ChildPush class, LC may be the first choice with the need for gallbladder resect that combined with liver cirrhosis.