腹腔镜胆囊切除术隐匿性肝硬化患者的预测及处理

Prediction and treatment of laparoscopic cholecystectomy in occult cirrhotic patients

目的探讨腹腔镜胆囊切除术(LC)中隐匿性肝硬化患者的预测及处理方法。方法对自1994年9月-2007年9月行胆囊切除术的术中发现肝硬化患者73例进行回顾性分析。结果LC成功73例,无一例中转。术前确诊慢性乙肝患者14例,HBsAb(+)患者57例,HCVAb(+)1例,酗酒史者3例。肝功能检查ALB平均为(38.7±3.2)g/L。术中发现明显肝硬化患者13例,轻度肝硬化者60例。术后引流液>500ml/d,为漏出液,肝功能检查第3dALB平均为(30.2±12.4)g/L,第7dALB平均为(37.5±2.4)g/L。全组无肝功能衰竭等严重并发症,均痊愈出院,术后平均住院(4.7±2.2)d。结论术前重视肝炎或曾经患过肝炎患者,术中注意观察肝脏硬化程度,术后加强肝功能检测及引流液的观察,积极保守治疗即可痊愈。

Objective To evaluate the prediction and treatment of laparoscopic cheolecystectomy(LC)in occult cirrhotic patients.Methods The data of 73 LC cases in cirrhotic patients were retrospectively analyzed.Results LC was successfully performed in 73 patients,no case were converted to open cholecystectomy.Before operation 14 cases were definitely diagnosed hepatitis B,l cases were HCV Ab(+),57 cases were HBsAb(+),3 cases were alcholism.ALB were average(38.7±3.2)g/L in liver function examination.During operation,13 cases were found obvious cirrhosis,60 cases were slight cirrhosis.After operation drainage fluid per day were exceeded 500 ml,the quality was transudate,ALB were average(30.2±2.4)g/L after 3 days and(37.5±2.4)g/L after 7 days.The liver function failure did not happen.All patients recovered smoothly and discharged from hospital within(4.7±2.2)days after LC.Conclusion The attention must be placed on the examination of hepatitis B、C and HBsAb(+)before LC,the degree of liver cirrhosis during LC,and liver function examination and drainage fuild observation after LC.