腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎合并肝炎后肝硬化的临床体会  

Clinical experience of laparoscopic cholecystectomy therapy on the treatment of cholecystolithiasis complicated with chronic cholecystitis in hepatic cirrhosis patients

作　　者：刘浩润[1] 崔洪涛[1] 李为民[1] 赵洪强[1] 许帅[1] 王义真 刘航[1] 

机构地区：[1]解放军第309医院肝胆外科,北京100091

出　　处：《临床消化病杂志》2015年第6期350-352,共3页Chinese Journal of Clinical Gastroenterology

摘　　要：[目的]探讨腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎合并肝炎后肝硬化的可行性及疗效。[方法]回顾性分析我科2007-08—2013-08期间42例合并肝炎后肝硬化胆囊结石伴慢性胆囊炎的患者,评估肝功能后择期在全身麻醉下行四孔法腹腔镜胆囊切除术后的临床资料。[结果]42例患者中39例在腹腔镜下完成胆囊切除术,2例因胆囊床出血不止、1例因胆囊三角出血并胆囊管显露困难中转开腹行胆囊切除术。42例术后均无胆瘘、腹腔出血、肝内外胆管及胃肠道损伤等严重并发症发生,5例出现一过性腹水、对症治疗后腹水消失,术前6例肝功能异常,术后21例肝功能异常,予以保肝治疗后恢复正常。[结论]腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎合并肝炎后肝硬化效果良好,但术中应注意难以控制的出血、及时中转开腹。[Objective]To investigate the feasibility and effect of laparoscopic cholecystectomy（LC）therapy in the treatment of cholecystolithiasis complicated with chronic cholecystitis in hepatic cirrhosis patients. [Methods]Clinical data of 42 hepatic cirrhosi cases with cholecystolithiasis and chronic cholecystitis from Aug 2007 to Aug 2013 in our department was analyzed retrospectively. In all patients, four-port LC was performed under general anesthesia after liver function assessment. [Results]Of the 42 patients, 39 cases underwent the operation successfully. The remaining 3 were converted to open cholecystectomy for the reasons of gallbladder bed bleeding（2 cases）and difficult exposing of the gallbladder triangle（1 case）. There were no biliary fistula,abdominal bleeding,hepatic and extrahepatic bile duct injury,gastrointestinal injury and other serious complications after operation. Transient ascites present in 5 cases and recovered after treatment. Before LC,6 cases had abnormal liver function, after LC, abnormal liver function occured in 21 cases and recovered after treatment in all the patients, [Conclusion]With the caution of unmanageable transoperative bleeding and timely conversion to laparotomy, LC can effectively treat the cholecystolithiasis with chronic cholecystitis in hepatitic cirrhosis.

关 键 词：腹腔镜胆囊切除术 肝炎后肝硬化 胆囊结石伴慢性胆囊炎 

分 类 号：R657.4[医药卫生—外科学]