【摘要】 目的探讨肝硬化患者腹腔镜胆囊切除术(LC)的安全可行性,比较MELD评分和Child-Pough分级两种方法对肝硬化患者行LC临床预后的预测价值。方法回顾分析近11年余收治的Child-PughA,B期肝硬化行LC的患者的临床资料55例,手术指征包括有症状的胆囊结石、胆囊炎、胆囊息肉及胆囊腺瘤;术前计算MELD评分和Child-Pugh分级,分析两者与临床预后的关系。结果围手术期无死亡病例。实施胆囊切除术53例(96.36%),胆囊次全切除术2例(3.64%)。平均手术时间(77±5.1)min。术中平均出血量为(51.0±3.33)mL。平均住院时间(5.0±1.3)d。术后并发症发生率为9.09%,包括出血、腹腔积液和切口感染,均经非手术治疗痊愈。ChildA期患者术后发生并发症4例(7.27%),ChildB期患者发生1例(10.0%)。MELD评分≤14分者发生术后并发症1例(2.44%),评分>14分者发生并发症4例(28.57%)。术前MELD评分>14分与<14分者术后并发症发生率间差异有统计学意义(P<0.05);Child-Pugh不同分级之间并发症发生率差异无统计学意义(P>0.05)。结论对于经过选择的肝硬化患者,LC是安全、可行的,术后并发症可控。相比于Child-Pugh分级,MELD评分能更有效地预测并发症发生率。更多还原

【Abstract】 Objective To evaluate the safety and feasibility of laparoscopic cholecystectomy(LC) in patients with cirrhosis,and compare the value of model for end-stage liver disease (MELD) score and Child-Pugh classification in predicting prognosis.Methods We reviewed the records of 55 laparoscopic cholecystectomies in cirrhotic patients in our department in the recent 11 years.Indications included symptomatic gallbladder disease,cholecystitis,cystic polyps and cystic adenoma.MELD score and Child-Pugh class were preoperatively calculated and associated with postoperative results.Data regarding patients and surgical outcome were retrospectively analyzed.Results No perioperative death occurred.Total cholecystectomy was employed in 53 patients and subtotal cholecystectomy in 2 patients.Median operative time was(77±5.1)min.Median intraoperative blood loss was(51.0±3.33)mL.Median hospital stay was(5.0±1.3)days.Postoperative complications occurred in 9.09% of the patients,including hemorrhage,intra-abdominal collections and wound complications,which were all controlled conservatively.The incidence of postoperative complications in Child A patients was 7.27%,in Child B was 10.0%;in MELD score below 14 was 2.44%,and in MELD score above 14 was 28.57%.The difference between rates of postoperative complications in patients with preoperative MELD score above 14 and below 14 was significant(P<0.05),while that between Child-Pugh A and B was not significant (P>0.05).Conclusions Laparoscopic cholecystectomy is a safe procedure for selected cirrhotic patients,and with controllable complications.MELD score appears to predict morbidity more accurately than Child-Pugh classification system.更多还原