合并肝硬化门脉高压患者的腹腔镜胆囊切除术

LAPAROSCOPIC CHOLECYSTECTOMY FOR THE PATIENTS WITH CIRRHOTIC PORTAL HYPERTENTSON

目的 探讨合并肝硬化门脉高压 (CPH)患者腹腔镜胆囊切除 (LC)的可行性与技术特点。方法 对照研究接受LC的 38例CPH组患者和 4 0例正常对照 (NC)组患者的治疗结果。CPH组包括肝功能ChildA级 2 1例 ,B级15例 ,C级 2例。结果 CPH组LC手术完成 36例 ,因术中出血、Calot三角区致密粘连中转各 1例。手术时间(5 2 .6± 15 .2 )min ,术中出血量 (75 .5± 15 .5 )ml。NC组 4 0例均LC手术完成 ,手术时间 (36 .2± 11.6 )min ,术中出血量 (32 .8± 13.4 )ml。术后CPH组 5例 (13.2 % )发生并发症 7例次 ,分别是戳孔感染 1例次 ,呼吸系统感染 1例次 ,泌尿系统感染 1例次 ,上消化道出血 1例次 ,轻度肝性脑病 1例次 ,腹水增多 2例次。均治愈出院 ,术后平均住院 (4.6± 2 .4 )d。NC组术后 1例 (2 .5 % )发生泌尿系统感染 ,术后平均住院 (3.0± 1.5 )d。两组患者在手术时间、术中出血量、中转率及术后并发症发生率、住院时间等方面均有显著性差异。结论 CPH患者的LC属于高难度的手术 ,是可行的、相对安全的 ,掌握手术的技术特点、注重围手术期处理是成功的关键。

Objective\ To evaluate the feasibility and technique characteristics of laparoscopic cholecystectomy (LC) for the patients with cirrhotic portal hypertension(CPH). Methods\ 78 patients were analyzed and divided into two groups, 38 patients were in the CPH group and 40 patients were in the normal control (NC) group. The hepatic function grades were 21 cases of Child A, 15 cases of Child B and 2 cases of Child C respectively in CPH group. Results\ In CPH group, LC was successfully performed in 36 cases, and other two patients were converted to open cholecystectomy for difficult managed bleeding under laparoscopy and dense adhesion of Calot′s triangle. The mean operative duration was (52.6± 15.2) min and the mean amount of bleeding during operation was (75.5± 15.5) ml. Seven postoperative complications were occurred in 5 patients (13.2%), including port-site infection, respiratory infection, urinary infection, upper digestive tract bleeding, slight hepatic encephalopathy and ascite increase. All patients were cured and discharged from hospital in (4.6±2.4) days after LC. In NC group, LC was successfully performed in all patients. The mean operative duration was (36.2± 11.6) min and the mean amount of bleeding during operation was (32.8±13.4) ml. Only one patient(2.5%)suffered from urinary infection. All patients discharged from hospital in (3.0±1.5) days after LC. There were significant differences in operative duration, amount of bleeding, convertible rate, post-operative complications and in-hospital duration after LC between two groups. Conclusions\ LC for CPH patients is very difficult, but it is feasible and relatively safe. The key steps for a successful operation are to acquaint with the technique characteristics, and pay attention to the peri-operative managements.