【摘要】 目的肝硬化患者行腹腔镜胆囊切除术因其风险较大而临床开展较谨慎,相关研究较少。文中旨在总结肝硬化合并胆囊结石伴胆囊炎患者进行腹腔镜下胆囊切除术治疗,观察患者的临床治疗效果并分析该治疗方案的可行性。方法回顾分析2012年1月至2015年12月常州市第三人民医院普通外科手术治疗的肝硬化合并胆囊结石胆囊炎患者112例。根据手术方式不同,分为腹腔镜组(行腹腔镜胆囊切除术)和开腹组(行开腹胆囊切除术),每组56例。记录手术时间、术中出血量、术后排气时间、术后住院时间、并发症等围手术期指标,进行统计学分析综合评价患者临床治疗效果。结果腹腔镜组患者行腹腔镜胆囊切除术其手术时间、术中出血量均明显优于开腹组[(54.28±15.34)min vs(91.63±20.09)min、(73.42±4.28)m L vs(98.54±7.16)m L,P=0.000];术后排气时间、术后住院时间亦明显优于开腹组(P=0.000)。腹腔镜组术后并发症发生率较开腹组明显降低(7.14%vs 21.43%,P<0.05)。结论肝硬化患者行腹腔镜胆囊切除术临床效果明显,在严格把握手术指征、合理评估手术风险的前提下腹腔镜胆囊切除术在肝硬化患者中安全可行。更多还原

【Abstract】 Objective Clinicians are very cautious on operationsof laparoscopic cholecystectomy( LC) in patients with cirrhosis because of its high risk. And few researches were carried out on this situation. This article aimed to summarize the LC in cirrhotic patients with cholecystolithiasis and cholecystitis,observe the clinical therapeutic effect and analyze the feasibility of this treatment.Methods The clinical data of 112 operation cases of cholecystolithiasis and cholecystitiswith cirrhosis were retrospectively analyzed from January 2012 to December 2015 in Department of General Surgery,Changzhou Third People’s Hospital. According to different surgical methods,all patients were divided into laparoscopic cholecystectomy group( n = 56) and open cholecystectomy group( n = 56).Peroperative period indicators including operation time,intraoperative blood loss,Postoperative exhaust time,postoperative hospital stay and complications were recorded,data were analyzed to evaluate the clinical effect. Results Compared with open cholecystectomy group,laparoscopic cholecystectomy group had shorter operative time[( 54.28±15.34) min vs( 91.63±20.09) min,P = 0.000]; less intraoperative blood loss[( 73.42±4.28) m L vs( 98.54±7.16) m L,P = 0.000],shorter Postoperative exhaust time and postoperative hospital stay( P = 0.000). The complication incidence in laparoscopic cholecystectomy group were lower than that in open cholecystectomy group( 7.14% vs 21.43%,P<0.05). Conclusion Operation of laparoscopic cholecystectomy on cirrhotic patients has a high clinical efficacy. It is safe and feasible to carry out such an operation on the basis of strict indication and reasonable risk assessment.更多还原