胆石症合并肝硬化门静脉高压症的治疗经验

Fherapy of cholelithiasis in patients of cirrhotic portal hypertension （CPH）

目的探讨胆石症合并肝硬化门静脉高压症的处理方法。方法回顾性分析总结胆石症合并肝硬变的患者共108例，行手术治疗78例。根据患者情况手术方式有经腹胆囊全切除、胆囊大部分切除术、经腹腔镜胆囊切除术、胆囊切除＋脾切除术、先行脾切除＋贲门周围血管离断术后行胆道手术、肝左外叶切除＋胆道手术以及肝门胆管整形胆管空肠Roux—en—Y吻合术。经内窥镜治疗10例，采取非手术治疗20例。结果本组108例患者治愈73例，治愈率67．6％，好转32例（29．7％），死亡3例（2．8％），死亡原因为大出血和肝功能衰竭。手术并发症为腹水、黄疸、出血及肝功能不全。结论对于胆石症合并肝硬化门静脉高压症的患者，术前应准确评估，采取合适的合理的手术方式，掌握术中处理技术，以及积极的围手术期处理。对于ChildC级患者应列为手术禁忌。

Objective To discuss the hypertension （CPH）. Method In this study, therapy of cholelithiasis complicated with cirrhotic portal clinical data were reviewed on 108 cases with cholelithiasis complicated with hepatic cirrhosis, including 78 cases who underwent surgery. Results Open cholecystectomy, subtotal cholecystectomy, laparoscopic cholecystectomy, open cholecystectomy plus spleectomy, splenectomy plus pericardia1 devascularization before biliary duct operation, leftlateral hepatectomy with biliary duct operation, and hepatic portal bile duct anaplasty with Roux-en-Y cholangiojejunostomy. 10 patients received endoscopic treatment and 20 were treated conservatively. Results 73 patients were cured, with a cure rate of 67.6%; 32 patients were doing well （29.7%）; 3 patients died （2. 8% ） of massive hemorrhage and hepatic failure. The operative complications included ascites, jaundice, hemorrhage and hepatic insufficiency. Conclusions Before operation, the conditions of the patient should be accurately evaluated and a correct operative treatment option should be selected. Child C grade patients should be contraindicated for any surgery.