腹腔镜治疗胆囊结石合并肝硬化106例体会

Laparoscopic Treatment of Gallstone with Cirrhosis： Retrospective Study of 106 Cases

目的 总结腹腔镜胆囊切除术治疗胆囊结石合并肝硬化的术中处理方式.方法 2010年1月—2016年1月,嘉兴市南湖区中心医院普外科共有106例胆囊结石合并肝硬化患者实行腹腔镜胆囊切除术治疗,对这些患者的术中处理细节进行回顾性分析.结果 99例顺利完成腹腔镜胆囊切除术,7例中转开腹行手术治疗（5例行胆囊大部分切除术）;手术时间36-122 min,平均56.5 min;术中失血量30-220 mL,平均48.5 mL;术后住院时间4-10 d,平均6.6 d.术后发生Trocar穿刺孔（取胆囊标本孔）感染1例、腹腔出血1例、肺部感染3例、腹水5例.结论 胆囊结石合并肝硬化患者行腹腔镜胆囊切除术,术前需要充分评估肝硬化引起肝门部门脉侧支循环的曲张程度,术中分离胆囊三角时操作应轻柔,避免误伤肝门部曲张的静脉.

Objective To evaluate the surgical techniques of laparoscopic cholecystectomy （LC） in patients with cholecystolithiasis and cirrhosis. Methods From January 2010 to January 2016, 106 patients with gallstones combined with cirrhosis in Department of General Surgery of Central Hospital of Nanhu District of Jiaxing were involved in this study, and the details of intraoperative treatment were retrospectively analyzed. Results Laparoscopic cholecystectomy was performed successfully in 99 cases of gallstones with cirrhosis and 7 cases were transferred to open laparotomy, of which 5 cases underwent resection of most part of gallbladder. The operation time was 36-122 minutes, with an average of 56.5 minutes. Intraoperative blood loss was 30-220 milliliter, with an average of 48.5 milliliter. Postoperative hospital stay was 4 to 10 days, the mean of which was 6.6 days. We also found 1 case of postoperative Trocar puncture hole （gallbladder specimen hole） infection, 1 case of abdominal bleeding, 3 cases of pulmonary infection and 5 cases of ascites. Conelusion It is essential to evaluate the degree of varices in the collateral circulation of hepatic portal vein before LC in patients with gallstones combined with cirrhosis. Besides, intraoperative separation of the gallbladder triangle should be gentle in order to avoid accidental injury of the hilar varicose veins.