腹腔镜手术治疗胆囊结石伴肝硬化的疗效观察

目的探讨胆囊结石伴肝硬化患者行腹腔镜胆囊切除术(LC)的可行性及临床疗效。 方法回顾性分析收治的105例胆囊结石伴肝硬化患者的临床资料。患者分成LC组(54例)和开腹胆囊切除术(OC)组(51例)，比较并分析两组间的手术时间、术中出血量、术后住院时间、总费用、术后并发症，肝功能的术前术后变化等指标；统计术后并发症的发生率，分析其发生的相关危险因素。 结果与OC组比较，LC组的手术时间 52.5(35～150)min vs 70(45～150)min]少、住院时间(3.9±2.9)d vs (9.5±4.8)d]更短，术中出血量50(20～280)ml vs 75(30～500)ml]更少，肝功能、肝功能Child-Pugh评分术前术后的变化更小，差异均有统计学意义(P<0.05)。术后并发症(11% vs 18%)、肝功能Child-Pugh分级术前术后的改变，两组间差异无统计学意义(P>0.05)。肝功能Child-Pugh分级、术前腹腔积液与胆囊结石伴肝硬化患者行胆囊切除术后并发症的发生有关(P<0.05)，术前腹腔积液 (OR ＝ 10.258, 95%CI 1.364-77.146, P＝0.024)是术后发生并发症的独立危险因素。 结论胆囊结石伴肝硬化患者(肝功能Child-Pugh A、B级)行LC是安全可行的；与OC相比，其具有术中手术时间短、术中出血少、术后住院时间短、对肝功能影响小的优势；此类患者行胆囊切除术后并发症的出现与术前腹腔积液密切相关。

Clinical observation of laparoscopic treatment of gallstone patients with cirrhosis

ObjectiveTo investigate the feasibility and benefits of laparoscopic cholecystectomy(LC)in cirrhotic patients with cholecystolithiasis. MethodsThe clinical data of 105 cases of cholecystolithiasis associated with liver cirrhosis were retrospectively analyzed. All patients were divided into laparoscopic cholecystectomy group (n=54) and open cholecystectomy group (n=51). The two groups were compared regarding operative time, blood loss, surgical complications, postoperative liver function, postoperative hospital stay and hospital costs. The incidence rate of the complications and the risk factors for the complications were also analyzed. ResultsAs compared with open cholecystectomy group, the operative time 52.5(35-150) min vs 70(45-150) min] and postoperative hospital stay (3.9±2.9) days vs (9.5±4.8) days] were shorter, blood loss was less 50(20-280)ml vs 75(30-500)ml], and the changes of liver function and Child-Pugh score were milder in laparoscopic cholecystectomy group. The differences were statistically significant (P<0.05). But the differences in postoperative complications and the change of Child-Pugh class between two groups were not significant (P>0.05). According to the univariate analysis, the Child-Pugh class and preoperative ascites were risks factors for the postoperative complications (P<0.05). Further analysis using multiple logistic regression illustrated that preoperative ascites was independent risk factor for the postoperative complications (OR=10.258, 95%CI 1.364-77.146, P=0.024). ConclusionsLaparoscopic cholecystectomy is an effective and safe treatment for symptomatic gallstone disease in patients with Child-Pugh A and B cirrhosis. The advantages over open cholecystectomy are the shorter operative time and postoperative hospital stay, the less blood less and the milder effect on liver function. The occurrence of the complications for the cirrhotic patients with cholecystolithiasis undergoing cholecystectomy is closely associated with the preoperative ascites.