腹腔镜胆囊切除术治疗胆囊结石伴肝硬化的临床分析
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摘要
目的探讨胆囊结石伴肝硬化患者行腹腔镜胆囊切除术(LC)的可行性以及临床疗效。方法回顾性分析2007年6月至2015年12月我院收治的147例胆囊结石伴肝硬化患者的临床资料,根据手术方式将患者分成腹腔镜胆囊切除术组(LC组,n=75)和开腹胆囊切除术组(OC组,n=72)。比较两组的手术时间、术中出血量、术后住院时间、总费用、术后并发症以及术前术后肝功能指标的差异并进行统计学分析。结果相较于OC组,LC组手术时间、术后住院时间更短,术中出血量更少,但总的住院费用较高;反映肝功能指标的白蛋白、谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶、总胆红素以及Child-Pugh评分在手术前后的变化更小,两组差异均具有统计学意义(P<0.05)。术后并发症、ICU入住率、Child-Pugh分级术前术后的改变,两组间差异无统计学意义(P>0.05)。结论肝功能Child-Pugh A、B级的胆囊结石伴肝硬化患者行LC是安全可行的。与开腹手术相比,LC具有手术时间短、术中出血少、术后住院时间短、对肝功能影响小的优势。
Objective To investigate the feasibility and benefits of laparoscopic cholecystectomy(LC) for the treatment of cholecystolithiasis patients with liver cirrhosis. Methods We retrospectively analyzed 147 cases of cholecystolithiasis patients with liver cirrhosis collected from Jun. 2007 to Dec. 2015. According to the operative methods, patients were divided into laparoscopic cholecystectomy group(LC group, n=75) and open cholecystectomy group(OC group, n=72). Operation duration, blood loss during operation, postoperative hospital stay, hospital costs, postoperative complications, pre- and postoperative liver function were compared in two groups. Results Compared with OC group, the operative duration(45~75 min vs 70~80 min) and postoperative hospital stay were shorter, blood loss was less, but the hospital costs were more. The changes of total bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase and Child-Pugh score were milder in LC group. All these differences between two groups were statistically significant(P<0.05). Differences in postoperative complications, ICU admission duration and the change of Child-Pugh classification between two groups were not statistically significant(P>0.05). Conclusion LC is an effective and safe treatment option for symptomatic cholecystolithiasis in patients with Child-Pugh A and B liver cirrhosis. The advantages of LC over OC are the shorter operation duration and postoperative hospital stay, the less blood loss and the milder effect on liver function.
Objective To investigate the feasibility and benefits of laparoscopic cholecystectomy(LC) for the treatment of cholecystolithiasis patients with liver cirrhosis. Methods We retrospectively analyzed 147 cases of cholecystolithiasis patients with liver cirrhosis collected from Jun. 2007 to Dec. 2015. According to the operative methods, patients were divided into laparoscopic cholecystectomy group(LC group, n=75) and open cholecystectomy group(OC group, n=72). Operation duration, blood loss during operation, postoperative hospital stay, hospital costs, postoperative complications, pre- and postoperative liver function were compared in two groups. Results Compared with OC group, the operative duration(45~75 min vs 70~80 min) and postoperative hospital stay were shorter, blood loss was less, but the hospital costs were more. The changes of total bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase and Child-Pugh score were milder in LC group. All these differences between two groups were statistically significant(P<0.05). Differences in postoperative complications, ICU admission duration and the change of Child-Pugh classification between two groups were not statistically significant(P>0.05). Conclusion LC is an effective and safe treatment option for symptomatic cholecystolithiasis in patients with Child-Pugh A and B liver cirrhosis. The advantages of LC over OC are the shorter operation duration and postoperative hospital stay, the less blood loss and the milder effect on liver function.
引文
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[12]冯龙,冯泽国,蔡守旺,等.控制性低中心静脉压技术在精准肝切除术中的应用[J].军医进修学院学报,2012,33(5):482-484.
[13]BESSA S S,ABDEL-RAZEK A H,SHARAAN M A,et al.Laparoscopic Cholecystectomy in cirrhotics:a prospective randomized study comparing the conventional diathermy and the harmonic scalpel for gallbladder dissection[J].J Laparoendosc Adv Surg Tech A,2011,21(1):1-5.
[14]徐庆,顾磊,吴志勇.胆石症合并肝硬化门静脉高压症术中和术后出血的处理[J].中华肝胆外科杂志,2006,12(12):814-816.
[15]MACHADO N O.Laparoscopic cholecystectomy in cirrhotics[J].JSLS,2012,16(3):392-400.
[16]SHAIKH A R,MUNEER A.Laparoscopic cholecystectomy in cirrhotic patients[J].JSLS,2009,13(4):592-596.
[17]LEANDROS E,ALBANOPOULOS K,TSIGRIS C,et al.Laparoscopic cholecystectomy in cirrhotic patients with symptomatic gallstone disease[J].ANZ J Surg,2008,78(5):363-365.
[18]PALANIVELU C,RAJAN P S,JANI K,et al.Laparoscopic cholecystectomy in cirrhotic patients:the role of subtotal cholecystectomy and its variants[J].J Am Coll Surg,2006,203(2):145-151.
[19]GIGER U,OUAISSI M,SCHMITZ S F,et al.Bile duct injury and use of cholangiography during laparoscopic cholecystectomy[J].Br J Surg,2011,98(3):391-396.
[20]LAURENCE J M,TRAN P D,RICHARDSON A J,et al.Laparoscopic or open cholecystectomy in cirrhosis:a systematic review of outcomes and meta-analysis of randomized trials[J].HPB(Oxford),2012,14(3):153-161.
[2]DEBRAY D,RAINTEAU D,BARBU V,et al.Defects in gallbladder emptying and bile acid homeostasis in mice with cystic fibrosis transmembrane conductance regulator deficiencies[J].Gastroenterology,2012,142(7):1581-1591.
[3]王子晨,张宁,陈卫刚,等.肝硬化合并胆囊结石临床特点分析105例[J].世界华人消化杂志,2015,23(8):1308-1313.
[4]PUGGIONI A,WONG L L.A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis[J].J Am Coll Surg,2003,197(6):921-926.
[5]MORINO M,CAVUOTI G,MIGLIETTA C,et al.Laparoscopic cholecystectomy in cirrhosis:contraindication or privileged indication[J].Surg Laparosc Endosc Percutan Tech,2000,10(6):360-363.
[6]NGUYEN K T,KITISIN K,STEEL J,et al.Cirrhosis is not a contraindication to laparoscopic cholecystectomy:results and practical recommendations[J].HPB(Oxford),2011,13(3):192-197.
[7]QUILLIN R C,BURNS J M,PINEDA J A,et al.Laparoscopic cholecystectomy in the cirrhotic patient:predictors of outcome[J].Surgery,2013,153(5):634-640.
[8]SHAIKH A R,MUNEER A.Laparoscopic cholecystectomy in cirrhotic patients[J].JSLS,2009,13(4):592-596.
[9]HAMAD M A,THABET M,BADAWY A,et al.Laparoscopic versus open cholecystectomy in patients with liver cirrhosis:a prospective,randomized study[J].Laparoendosc Adv Surg Tech A,2010,20(5):405-409.
[10]DE GOEDE B,KLITSIE P J,HAGEN S M,et al.Meta-analysis of laparoscopic versus open cholecystectomy for patients with liver cirrhosis and symptomatic cholecystolithiasis[J].Br J Surg,2013,100(2):209-216.
[11]辛建,陶凯雄,夏泽锋,等.腹腔镜手术治疗合并肝硬化胆囊结石的临床分析[J].华中科技大学学报(医学版),2010,39(4):532-535.
[12]冯龙,冯泽国,蔡守旺,等.控制性低中心静脉压技术在精准肝切除术中的应用[J].军医进修学院学报,2012,33(5):482-484.
[13]BESSA S S,ABDEL-RAZEK A H,SHARAAN M A,et al.Laparoscopic Cholecystectomy in cirrhotics:a prospective randomized study comparing the conventional diathermy and the harmonic scalpel for gallbladder dissection[J].J Laparoendosc Adv Surg Tech A,2011,21(1):1-5.
[14]徐庆,顾磊,吴志勇.胆石症合并肝硬化门静脉高压症术中和术后出血的处理[J].中华肝胆外科杂志,2006,12(12):814-816.
[15]MACHADO N O.Laparoscopic cholecystectomy in cirrhotics[J].JSLS,2012,16(3):392-400.
[16]SHAIKH A R,MUNEER A.Laparoscopic cholecystectomy in cirrhotic patients[J].JSLS,2009,13(4):592-596.
[17]LEANDROS E,ALBANOPOULOS K,TSIGRIS C,et al.Laparoscopic cholecystectomy in cirrhotic patients with symptomatic gallstone disease[J].ANZ J Surg,2008,78(5):363-365.
[18]PALANIVELU C,RAJAN P S,JANI K,et al.Laparoscopic cholecystectomy in cirrhotic patients:the role of subtotal cholecystectomy and its variants[J].J Am Coll Surg,2006,203(2):145-151.
[19]GIGER U,OUAISSI M,SCHMITZ S F,et al.Bile duct injury and use of cholangiography during laparoscopic cholecystectomy[J].Br J Surg,2011,98(3):391-396.
[20]LAURENCE J M,TRAN P D,RICHARDSON A J,et al.Laparoscopic or open cholecystectomy in cirrhosis:a systematic review of outcomes and meta-analysis of randomized trials[J].HPB(Oxford),2012,14(3):153-161.