肝硬化合并胆石症的手术治疗

Surgical treatment of cholelithiasis in patients with cirrhosis

目的 :探讨肝硬化合并胆石症患者的手术风险及预后。方法 :对我院 1994～ 2 0 0 0年间收治的 42例肝硬化合并胆石症患者的临床资料进行回顾分析。结果 :42例肝硬化合并胆石症患者中 ,肝功能ChildA级 19例 ,ChildB级 18例 ,ChildC级 5例。急诊手术 15例 ,择期手术 2 7例。术中出血量 10 0 0ml以上 13例。术后出现并发症 2 2例 ,其中ChildA级 6例 (占 31.6 % ) ,B级 12例 (占 6 6 .7% ) ,C级 4例 (占 80 .0 % )。治愈2 9例 ,死亡 6例 ,术后胆道残余结石 7例。结论 :Child分级适用于肝硬化患者胆道手术风险的评估。

Objective:To evaluate the surgical risks and prognostic factor of cholelithiasis in patients with cirrhosis.Methods:A retrospective analysis was made on 42 cholelithiasis in patients with cirrhosis admitted to our hospital from Feb.1994 to May 2000.Results:15 cases underwent emergency operation and 27 cases did selective surgery. Hemorrhage during the operation was more than 1000ml in 13 cases. Twenty two cases(52.4%) suffered from postoperative complications and 6 of them(14.3%) died. The rate of complication in Child's class A patients was 31.6%(6/19), in Child's class B was 66.7%(12/18) and in Child's class C was 80.0%(4/5). In this group, the stones of 29 cases were removed completely, 7 cases had residual cholelithiasis.Conclusion:The Child's classification can be used to evaluate the surgical risks of cholelithiasis in patients with cirrhosis. The operative bleeding and liver failure are the major prognostic factors in these patients.