肝硬化对腹腔镜胆囊切除患者术后短期预后的影响

Effect of liver cirrhosis on short-term prognosis of patients after laparoscopic cholecystectomy

目的探讨肝硬化对腹腔镜胆囊切除患者术后短期预后的影响。方法纳入2016年1月至2021年6月新疆医科大学第一附属医院因胆囊疾病行腹腔镜胆囊切除术的176例患者,按是否合并肝硬化分为肝硬化组和无肝硬化组,比较两组患者围术期一般临床资料以及术后并发症发生情况,分别采用多因素分析获得影响所有患者和肝硬化患者腹腔镜胆囊切除术后短期预后的独立危险因素。结果肝硬化组胆囊壁厚度≥5 mm以及多发结石所占的比例明显高于无肝硬化组,其手术时间以及术后出血量明显高于无肝硬化组,肝硬化组患者术后腹腔出血以及感染所占的比例明显高于无肝硬化组。Logistic多因素分析显示,肝硬化、Calot三角粘连以及胆囊壁厚度≥5 mm成为影响腹腔镜胆囊切除患者术后短期预后的独立危险因素,肝硬化患者腹腔镜胆囊切除术后发生严重并发症或死亡的风险是无肝硬化患者的2.776倍(OR:2.776,95%CI:1.185~6.506,P=0.019);Child-Pugh分级、MELD评分、Calot三角粘连成为影响肝硬化患者腹腔镜胆囊切除术后短期预后的独立危险因素。结论肝硬化明显增加腹腔镜胆囊切除患者发生术后并发症和不良预后的风险,而MELD评分和Child-Pugh分级可用于准确评估肝硬化患者该术式术后并发症的发生风险及预后。

Objective To investigate the effect of liver cirrhosis on short-term prognosis of patients after laparoscopic cholecystectomy.Methods 176 patients who underwent laparoscopic cholecystectomy for gallbladder diseases in the First Affiliated Hospital of Xinjiang Medical University from January 2016 to June 2021 were included.They were divided into cirrhosis group and non cirrhosis group according to whether they were complicated with liver cirrhosis.The perioperative general clinical data and postoperative complications of the two groups were compared.Multivariate analysis were used to obtain independent risk factors affecting the short-term prognosis after laparoscopic cholecystectomy in all patients and patients with liver cirrhosis.Results The proportion of gallbladder wall thickness≥5 mm and multiple stones in the liver cirrhosis group was significantly higher than that in the non liver cirrhosis group,the operation time and postoperative bleeding volume were significantly higher than those in the non liver cirrhosis group.The proportion of postoperative abdominal bleeding and infection in the liver cirrhosis group was significantly higher than that in the non liver cirrhosis group.Multivariate Logistic analysis showed that liver cirrhosis,Calot triangle adhesion and gallbladder wall thickness≥5 mm became independent risk factors affecting the short-term prognosis of patients after laparoscopic cholecystectomy.The risk of serious complications or death after laparoscopic cholecystectomy in patients with liver cirrhosis was 2.776 times higher than that in patients without liver cirrhosis(OR:2.776,95%CI:1.185~6.506,P=0.019),Child-Pugh grade,MELD score,Calot triangle adhesion become independent risk factors for short-term prognosis of patients with liver cirrhosis after laparoscopic cholecystectomy.ConclusionLiver cirrhosis significantly increases the risk of postoperative complications and poor prognosis of patients after laparoscopic cholecystectomy.MELD score and Child-Pugh grade can be used to accurately evaluate the risk of postoperative complications and prognosis of patients with liver cirrhosis.