腹腔镜胆囊切除术治疗胆囊结石伴肝硬化的临床分析  

Clinical analysis of laparoscopic cholecystectomy for treatment of cholecystolithiasis patients with liver cirrhosis

作　　者：张驰豪[1] 桂亮[1] 刘晔[2] 秦骏[2] 郑磊[1] 钱彬彬[1] 邓文升 罗蒙[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院普外科,上海201999 [2]上海交通大学医学院附属仁济医院普外科,上海200127

出　　处：《肝胆胰外科杂志》2016年第6期454-459,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：上海市宝山区科委项目(13-E-4)

摘　　要：目的探讨胆囊结石伴肝硬化患者行腹腔镜胆囊切除术(LC)的可行性以及临床疗效。方法回顾性分析2007年6月至2015年12月我院收治的147例胆囊结石伴肝硬化患者的临床资料,根据手术方式将患者分成腹腔镜胆囊切除术组(LC组,n=75)和开腹胆囊切除术组(OC组,n=72)。比较两组的手术时间、术中出血量、术后住院时间、总费用、术后并发症以及术前术后肝功能指标的差异并进行统计学分析。结果相较于OC组,LC组手术时间、术后住院时间更短,术中出血量更少,但总的住院费用较高;反映肝功能指标的白蛋白、谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶、总胆红素以及Child-Pugh评分在手术前后的变化更小,两组差异均具有统计学意义(P<0.05)。术后并发症、ICU入住率、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)。结论肝功能Child-Pugh A、B级的胆囊结石伴肝硬化患者行LC是安全可行的。与开腹手术相比,LC具有手术时间短、术中出血少、术后住院时间短、对肝功能影响小的优势。Objective To investigate the feasibility and benefits of laparoscopic cholecystectomy （LC） for the treatment of cholecystolithiasis patients with liver cirrhosis. Methods We retrospectively analyzed 147 cases of cholecystolithiasis patients with liver cirrhosis collected from Jun. 2007 to Dec. 2015. According to the operative methods, patients were divided into laparoscopic cholecystectomy group （LC group, n=15） and open cholecystectomy group （OC group, n=12）. Operation duration, blood loss during operation, postoperative hospi-tal stay, hospital costs, postoperative complications, pre- and postoperative liver function were compared in two groups. Results Compared with OC group, the operative duration （45？75 min vj 70？ 80 min） and postoperative hospital stay were shorter, blood loss was less, but the hospital costs were more. The changes of total bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase and Child-Pugh score were milder in LC group. All these differences between two groups were statistically significant （^O.OS）. Differences in postoperative complications, ICU admission duration and the change of Child-Pugh classification between two groups were not statistically significant （P〉0.05）. Conclusion LC is an effective and safe treatment option for symptomatic cholecystolithiasis in patients with Child-Pugh A and B liver cirrhosis. The advantages of LC over OC are the shorter operation duration and postoperative hospital stay, the less blood loss and the milder effect on liver function.

关 键 词：胆囊结石 肝硬化 胆囊切除术 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]