肝硬化患者行腹腔镜胆囊切除术的安全性分析

目的探讨胆囊结石伴肝硬化患者行腹腔镜胆囊切除术（LC）的安全性。方法回顾性分析2010～2011年我院497例因胆囊结石行LC病例。其中胆囊结石合并肝硬化患者41例（Child-Pugh分级A～C级）,对照组456例。对两组间术中及手术后各项指标进行统计学分析。结果肝硬化组4例中转开腹。肝硬化组平均手术时间、住院时间较对照组延长（P〈0.05）。肝硬化组出血量增多（P〈0.05）,术后并发症发生率34.15%。肝硬化组Trocar穿刺口血肿、切口并发症等发生率较对照组为高（P〈0.05）,有2例因术后胆囊床渗血再次手术止血。2例Child-Pugh分级C级和2例Child-Pugh分级B级患者术后大量腹水。1例Child-Pugh B级患者术后胆漏,经保守治疗痊愈。无患者死亡。结论相比普通患者,肝硬化患者行LC虽然手术时间延长、并发症增多,仍不失为安全有效的治疗方法。对Child-Pugh C级患者则要慎重对待。

Safety analysis of laparoscopic cholecystectomy in cirrhotic patients

Objective To analyze safety of laparoscopic cholecystectomy（LC） in cirrhotic patients with cholecystolithiasis.Methods Retrospective analysis of 497 cases information of LC for cholecystolithiasis from 2010 to 2011,including 41 patients with liver cirrhosis and 456 patients without liver cirrhosis.The operative time 、blood loss、length of hospital stay and surgical complications were compared between the two groups.Results Conversion to an open procedure was necessary in 4 patients in cirrhotic patients.The mean operative time and length of hospital stay were significantly longer in cirrhotic group（P〈0.05）.The mean blood loss was more than control group（P〈0.05）.Postoperative complications were observed in 34.15% of cirrhotic patients.Trocar site hematoma（P〈0.05）,wound complications（P〈0.05） occurred more frequently in patients with cirrhosis（Child B and C class） than in patients without cirrhosis.Two cases of continuing hemorrhage from the gallbladder bed required re-operation for hemostasis.Two patients with Child-Pugh class C and two patients with class B cirrhosis developed ascites after surgery;one patient with Child-Pugh class B had bile leakage.No deaths occurred.Conclusion LC is an effective and safe procedure in patients with liver cirrhosis,although it has longer operative time and more postoperative complications.For patients with Child-Pugh class C,the surgery should be avoided unless clearly indicated.