一项关于肝硬化患者腹腔镜胆囊切除术的前瞻性病例研究

Laparoscopic cholecystectomy in cirrhotic patients:A prospective case control study

目的探讨腹腔镜胆囊切除术治疗合并肝硬化的胆囊结石患者的可行性和疗效。方法前瞻性选取2007年～2010年收治的21例合并肝硬化(肝功能Child-Pugh A,B级)的胆囊结石患者为试验组,并随机选取同期基本资料相同的21名非肝硬化患者作为对照组,对两组间手术中及手术后各项指标进行统计学分析。结果试验组的中转率和严重并发症发生率均高于对照组,但差异无统计学意义。试验组的手术时间、术中出血量、平均住院总费用和平均住院日均高于对照组,且差异具有统计学意义。结论对合并肝硬化的胆囊结石患者实施腹腔镜胆囊切除术是安全可行的,但较非肝硬化患者而言手术难度更大且花费更多。

Objective To investigate the feasibility and benefits of Laparoscopic cholecystectomy （LC）in cirrhotic patients with cholecystolithiasis. Methods From January 2007 to January 2010, 21 cases of cholecystolithiasis associated with liver cirrhosis were prospective selected to be test group, and other 21 cholecystolithiasis patients without liver cirrhosis were randomly chosed to be control group. The operative time,blood loss, length of hospital stay, hospital costs, surgical complications were compared between the two groups. Results Both the conversion rate and major complications were increased in the cirrhotic group ,but the difference was not statistically significant. The operative time, blood loss, the hospital costs and hospital stay of test group were all more than control group, and the difference was statistically significant. Conclusion Laparoscopie cholecysteetomy is an effective and safe treatment on liver cirrhosis patients （ Child-Pugh A or B ） with cholecystolithiasis, and it is more difficult and expensive than on noncirrhotic patients.