胆囊结石合并肝硬化门静脉高压症行腹腔镜胆囊切除临床分析

Clinical analysis of laparoscopic cholecystectomy for cholecystolithiasis complicated with liver cir-rhosis and portal hypertension

目的：分析与总结腹腔镜胆囊切除术治疗合并肝硬化门静脉高压症的胆囊结石患者的临床疗效，为临床手术方案选择提供参考依据。方法对60例胆囊结石合并肝硬化门静脉高压症患者行腹腔镜胆囊切除术治疗，对围手术期和手术的处理方法、效果等进行分析总结。结果60例患者全部治愈，手术时间平均50 min，无胆道损伤、术后出血及腹腔感染等并发症发生，9例患者术后留置了腹腔引流管，住院时间8-15 d，平均12 d。结论术前行肝功能Child分级、行肝胆增强CT了解肝十二指肠韧带处血管情况，以及胆囊病变程度，采取积极的预防措施，改善肝功能，术中仔细操作，采用腹腔镜胆囊切除术治疗胆囊结石合并肝硬化门静脉高压症是安全可靠的，手术效果良好。

Objective To analyze and summarize the clinical efficacy of laparoscopic cholecys-tectomy for cholecystolithiasis complicated with liver cirrhosis and portal hypertension and provide refer-ences for surgical options. Methods Sixty cases of cholecystolithiasis complicated with liver cirrhosis and portal hypertension underwent laparoscopic cholecystectomy. Surgical management and effects during perio-perative and operative period were analyzed and summarized. Results All patients were cured with a mean operation time of 50min. All patients recovered well without bile duct injury,postoperative bleeding, abdominal infection and other complications. Peritoneal drainage catheter was placed in 13 patients postop-eratively. Hospitalization ranged from 8 to 15d with an average of 11. 5 d. Conclusion Child′s classifica-tion should be evaluated preoperatively. Enhanced CT of hepatobiliary system can be helpful in understand-ing vessels of the hepatoduodenal ligament and severity of cholecystic lesions. Positive preventive measures should be taken in improving liver functions and the operation should be careful. Laparoscopic cholecystec-tomy for cholecystolithiasis complicated with liver cirrhosis and portal hypertension is safe and reliable with satisfied results.