【摘要】 目的探讨合并肝硬化的急性坏疽性胆囊炎(acute gangrenous cholecystitis,AGC)安全可行的腹腔镜手术实施策略。方法回顾性分析本院(新疆医科大学第一附属医院)2015年1月-2019年5月间合并肝硬化的AGC患者47例,对照组26例,接受经腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC);实验组21例,接受经腹腔镜肝门阻断+胆囊大部分切除术(laparoscopic subtotal cholecystectomy,LSC)。对比分析两组间的手术指标(手术时间、术中出血、中转开腹、引流管拔除时间、进食时间和住院时间)、围手术期肝功能的影响(Child分级)和实验室指标(血清总胆红素、谷丙转氨酶、血清白蛋白、凝血酶原时间、腹水总量、肝性脑病)、围手术期感染指标(白细胞计数、降钙素原)和术后短期并发症发生率。结果实验组的手术时间、术中出血、中转开腹、引流管拔除时间、住院时间均低于对照组(P <0.05);实验组围手术期对肝功能的影响低于对照组(P <0.05),特别是血清白蛋白、凝血酶原时间、腹水总量的变化均低于对照组(P <0.05);实验组白细胞计数和降钙素原恢复正常的时间均低于对照组(P <0.05);实验组术后短期并发症(7 d内)发生率低于对照组(P <0.05)。结论对于合并肝硬化的AGC,经腹腔镜肝门阻断+LSC能够有效控制出血、减少手术损伤、缩短手术时间,进而减少围手术期肝功能的影响、有效控制感染、降低并发症的发生,是安全可行的腹腔镜手术实施策略。更多还原

【Abstract】 Objective To Discuss about the safe and applicable method of laparoscopic surgery about AGC(acute gangrenous cholecystitis, AGC)with liver cirrhosis. Methods 47 patients having AGC with liver cirrhosis from January 2015 to May 2019 were studied retrospectively. Among those patients, 26 patients were chosen in the control group who underwent LC, and other 21 patients who were divided into the experimental group underwent LSC with Pringle’s hepatic inflow occlusion. Two groups were compared and analyzed about the surgical data(including operation time, blood loss, conversion rate of laparoscopic surgery, drainage tube removal time, fasting time and hospital stays), effects of perioperative liver function(Child-Pugh), the data from laboratory tests(TBIL, ALT, ALB, PT, total ascites and hepatic encephalopathy), the data of perioperative infection(WBC and PCT)and the incidence of short-term postoperative complications. Results The operation time, blood loss, conversion rate of laparoscopic surgery, drainage tube removal time and hospital stays in the experimental group were lower than those in the control group(P < 0.05). The perioperative liver function, especially ALB, PT and total ascites value in the experimental group was lower than those in the control group(P < 0.05),(P < 0.05). The recovery time of WBC and PCT in the experimental group were lower than those in the control group(P < 0.05). The incidence of short-term(7 days)postoperative complications in the experimental group was lower than that in the control group(P < 0.05). Conclusions LSC with Pringle’s hepatic inflow occlusion can effectively reduce bleeding and the operation injury, shorten the operation time, and further reduce the effects on perioperative liver function, effectively control the infection and reduce the incidence of complications for AGC with liver cirrhosis. It’s a safe and applicable method of laparoscopic surgery.更多还原