肝硬化合并胆道结石23例分析

Analysis of 23 Cases of liver Cirrhosis with Combined Cholelithiasis

目的:探讨肝硬化合并胆道结石的临床特点。方法:应用临床流行病学方法,对23例肝硬化合并胆道结石的临床表现、辅助检查、治疗方法及其结果进行分析。结果:本组肝硬化合并胆道结石的发生率为21.3%,有上腹部饱胀或隐痛78.2%,发热伴右上腹绞痛和压痛21.7%。其中肝功能Child-Pugh分级A级合并胆囊结石21.7%,B级合并胆囊结石30.4%,C级合并胆囊结石、胆囊结石合并胆总管结石共占47.8%。经内科保守治疗症状改善或缓解78.5%。手术病人中,肝功能Child- Pugh分级C级2例死亡,占22.2%。结论:肝硬化病人合并胆道结石的发生率较普通人群高,多数缺乏胆石症的典型临床表现,或其症状被肝病的临床症状所掩盖。应常规行胆道系统的B超检查,必要时行CT或MRI检查。此类病人对手术耐受性差,并发症多,需严格掌握手术适应证。

Objective: To explore the clinical features of liver cirrhosis combined with cholelithiasis. Methods: Clinical and labortory findings,therapeutic approaches and results of treatment in 23 cases of liver cirrhosis combined with cholelithiasis were analyzed with clinic epidemiology method. Results: In this group, the incidence of liver cirrhosis associated with cholelithiasis was 21. 3%. Epigastric distention or dull pain was present in 78. 2% of cases,and fever accompanied with biliary colic and tenderness in right upper puadrant in 21. 7% of cases. Among them,21. 7% of the patients of Class A in Child-Pugh' s criteria for hepatic functional reserve had cholecystolithiasis, 30. 4% of the patients of Class B had cholecystolithiasis and 47.8% of the patiens of Class C had cholecystolithiasis or cholecystolithiasis with choledochohthiasis. In 78. 5% of cases, symptoms were improved or alleviated through conservative treatment. Among the patients undergoing operation,two patients of Class C in Child-Pugh's criteria died, showing a mortality of 22. 2%. Conclusion: The incidence of cholelithiasis in patients with liver cirrhosis is higher than that of in common population. In most patients,typical clinical findings of cholelithiasis may not be present or may be concealed by those of liver diseases. B-mode ultrasonograpgy and,if necessary,computed tomograpgy or magnetic resonance imaging of biliary tract should be routinely performed in the patients. The patients can not tolerate operation well,and there may be a lot of complications. Therefore,the indications of operation must be strictly observed.