腹腔镜胆囊切除术治疗酒精性肝硬化合并胆囊结石患者临床疗效及其并发症相关危险因素分析

Clinical efficacy and related risk factors of com plications in alcoholicliver cirrhosis patients with gallstone after laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术(LC)治疗肝硬化合并胆囊结石患者的临床疗效及其术后发生并发症的相关因素。方法 2013年12月～2016年12月就诊的酒精性肝硬化合并胆囊结石患者120例,按手术方法的不同分为两组,60例接受经右上腹腹直肌切口开腹切除胆囊,另60例接受LC术,比较两组患者手术指标及其术后并发症发生率情况,并对LC患者术后发生并发症的相关因素进行单因素和多因素Logistic回归分析。结果 LC组术中出血量为(100.6±24.9)ml,显著少于开腹组的(139.6±38.6)ml,差异有统计学意义(P<0.05),LC手术时间为(53.9±18.6)min,显著短于开腹组的(76.2±23.1)min,差异有统计学意义(P<0.05),术后排气时间为(28.4±8.6)h,显著短于开腹组的(50.6±13.6)h,差异有统计学意义(P<0.05),住院时间为(5.8±2.9)d,显著短于开腹组的(10.0±4.6)d,差异有统计学意义(P<0.05);LC患者术后并发症发生率为8.3%,显著低于开腹组的21.7%,差异有统计学意义(P<0.05);胆囊壁厚度、Calot三角粘连、周围脏器粘连、胆囊颈部结石等4个单因素为LC术后发生并发症的相关因素,差异有统计学意义(P<0.05),并经多因素Logistic回归分析证实。结论 LC术治疗酒精性肝硬化合并胆囊结石患者疗效显著,术后发生并发症的主要危险因素主要与Calot三角粘连、周围脏器粘连、胆囊颈部结石和胆囊壁增厚等有关,可通过严格掌握手术操作技巧来预防术后并发症的发生。

Objective To analyze the clinical efficacy and related risk factors of complications in alcoholicliver cirrhosis patients with gallstone after laparoscopic cholecystectomy （LC） . Methods 120 alcoholic liver cirrhosispatients with gallstones were recruited and treated in our hospital between December 2013 and December 2016. Thepatients were divided into two groups, 60 of them received cholecystectomyby conventional right upper abdominalincision, and another 60 underwent LC. The surgery parameters and postoperative complications in the two groupswere compared, and univariate and multivariate Logistic regression analysis were used to analyze the related factorsof postoperative complications in the LC group. Results The bleeding in LC group was（100.6±24.9）ml, lesserthan（139.6±38.6）ml in conventional group（the difference was statistical significant, P〈0.05）; the operative timewas （53.9±18.6）min, much shorter than（76.2±23.1）min in the conventional group（the difference was statisticalsignificant, P〈0.05）; the postoperative exhaust time was（28.4±8.6）h, apparently shorter than（50.6±13.6）h in theconventional group （the difference was statistical significant, P〈0.05）; the hospitalization time was （5.8±2.9）d,obviously shorter than（10.0±4.6）d in the conventional group（the difference was statistical significant, P〈0.05）;the incidence of postoperative complications was 8.3%, significantly lower than 21.7% in the conventional group（the difference was statistical significant, P〈0.05）; the gallbladder wall thickness, Calot triangle adhesion, surroundingorgan adhesion and gallbladder neck stone were found to be the related risk factors for complications after LC,and the finding was confirmed by multivariate Logistic regression analysis. LC has significant efficacyin treatment of alcoholic liver cirrhotic patients withgallbladder stones, and the main risk factors forpostoperative complications occurrence are calottriangle adhesion, adhesion of peripheral organs,gallbladder neck stone and the increased thickness ofgallbladder wall. Surgeon might pay attention to prevent the postoperative complications after LC by strict controlof surgical process.