Clinical observation of laparoscopic treatment of gallstone patients with cirrhosis

Gui Liang; Liu Ye; Qin Jun; Zheng Lei; Qian Binbin; Huang Yijun; Luo Meng

doi:10.3877/cma.j.issn.1674-6899.2016.03.013

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腹腔镜手术治疗胆囊结石伴肝硬化的疗效观察

中华腔镜外科杂志（电子版）, 2016,9(3) : 175-179. DOI: 10.3877/cma.j.issn.1674-6899.2016.03.013

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)的可行性及临床疗效。

方法

回顾性分析收治的105例胆囊结石伴肝硬化患者的临床资料。患者分成LC组(54例)和开腹胆囊切除术(OC)组(51例)，比较并分析两组间的手术时间、术中出血量、术后住院时间、总费用、术后并发症，肝功能的术前术后变化等指标；统计术后并发症的发生率，分析其发生的相关危险因素。

结果

与OC组比较，LC组的手术时间 [52.5(35～150)min vs 70(45～150)min]少、住院时间[(3.9±2.9)d vs (9.5±4.8)d]更短，术中出血量[50(20～280)ml vs 75(30～500)ml]更少，肝功能、肝功能Child-Pugh评分术前术后的变化更小，差异均有统计学意义(P<0.05)。术后并发症(11% vs 18%)、肝功能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)。肝功能Child-Pugh分级、术前腹腔积液与胆囊结石伴肝硬化患者行胆囊切除术后并发症的发生有关(P<0.05)，术前腹腔积液 (OR ＝ 10.258, 95%CI 1.364-77.146, P＝0.024)是术后发生并发症的独立危险因素。

结论

胆囊结石伴肝硬化患者(肝功能Child-Pugh A、B级)行LC是安全可行的；与OC相比，其具有术中手术时间短、术中出血少、术后住院时间短、对肝功能影响小的优势；此类患者行胆囊切除术后并发症的出现与术前腹腔积液密切相关。

引用本文: 桂亮, 刘晔, 秦骏, 等. 腹腔镜手术治疗胆囊结石伴肝硬化的疗效观察 [J/CD] . 中华腔镜外科杂志（电子版）,2016,9 (3): 175-179. DOI: 10.3877/cma.j.issn.1674-6899.2016.03.013

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肝硬化患者胆囊结石的发病率至少是非肝硬化患者的2倍，脾功能亢进、雌激素水平的升高、胆囊收缩与排空能力的降低都与之相关^[1,2,3]。肝硬化门静脉高压症患者均存在不同程度的肝功能损害与凝血功能障碍，腹部外科手术难度大且风险极高。由于担心潜在的出血与术后肝衰竭的风险，肝硬化一度被认为是腹腔镜胆囊切除术(LC)的绝对或相对禁忌证^[4]。随着腹腔镜设备的不断改进和手术技术的不断更新，LC的适应证也在逐渐放宽。对于肝功能Child-Puch A、B级的胆囊结石伴肝硬化患者，LC是一种安全的术式^[5,6]。

贡献者信息

桂亮

201999　上海交通大学医学院附属第九人民医院普外科

刘晔

200127　上海交通大学医学院附属仁济医院普外科

秦骏

200127　上海交通大学医学院附属仁济医院普外科

郑磊

201999　上海交通大学医学院附属第九人民医院普外科

钱彬彬

201999　上海交通大学医学院附属第九人民医院普外科

黄毅军

201999　上海交通大学医学院附属第九人民医院普外科

罗蒙

201999　上海交通大学医学院附属第九人民医院普外科

通信作者

罗蒙

201999　上海交通大学医学院附属第九人民医院普外科

Email：luotysy@sina.com

关键词

胆囊结石; 肝硬化; 腹腔镜胆囊切除术;

基金项目

上海市宝山区科委项目（13-E-4）

作者声明

桂亮，刘晔，秦骏，等．腹腔镜手术治疗胆囊结石伴肝硬化的疗效观察[J/CD]．中华腔镜外科杂志：电子版，2016，9(3)：175－179.

历史

出版日期：2016-06-30

收稿日期：2016-01-30

本文编辑

银冰

Short Original Article

Clinical observation of laparoscopic treatment of gallstone patients with cirrhosis

Gui Liang, Liu Ye, Qin Jun, Zheng Lei, Qian Binbin, Huang Yijun, Luo Meng

Published 2016-06-30

Cite as Chin J Laparoscopic Surgery(Electronic Edition), 2016,9(3): 175-179. DOI: 10.3877/cma.j.issn.1674-6899.2016.03.013

Abstract

Objective

To investigate the feasibility and benefits of laparoscopic cholecystectomy(LC)in cirrhotic patients with cholecystolithiasis.

Methods

The clinical data of 105 cases of cholecystolithiasis associated with liver cirrhosis were retrospectively analyzed. All patients were divided into laparoscopic cholecystectomy group (n=54) and open cholecystectomy group (n=51). The two groups were compared regarding operative time, blood loss, surgical complications, postoperative liver function, postoperative hospital stay and hospital costs. The incidence rate of the complications and the risk factors for the complications were also analyzed.

Results

As compared with open cholecystectomy group, the operative time [52.5(35-150) min vs 70(45-150) min] and postoperative hospital stay[ (3.9±2.9) days vs (9.5±4.8) days] were shorter, blood loss was less [50(20-280)ml vs 75(30-500)ml], and the changes of liver function and Child-Pugh score were milder in laparoscopic cholecystectomy group. The differences were statistically significant (P<0.05). But the differences in postoperative complications and the change of Child-Pugh class between two groups were not significant (P>0.05). According to the univariate analysis, the Child-Pugh class and preoperative ascites were risks factors for the postoperative complications (P<0.05). Further analysis using multiple logistic regression illustrated that preoperative ascites was independent risk factor for the postoperative complications (OR=10.258, 95%CI 1.364-77.146, P=0.024).

Conclusions

Laparoscopic cholecystectomy is an effective and safe treatment for symptomatic gallstone disease in patients with Child-Pugh A and B cirrhosis. The advantages over open cholecystectomy are the shorter operative time and postoperative hospital stay, the less blood less and the milder effect on liver function. The occurrence of the complications for the cirrhotic patients with cholecystolithiasis undergoing cholecystectomy is closely associated with the preoperative ascites.

Key words:

Cholecystolithiasis; Liver cirrhosis; Laparoscopic cholecystectomy

Contributor Information

Gui Liang