Application of Laparoscopic Cholecystectomy in the Therapy of Cholelithiasis Associated with Liver Cirrhosis_West China Medical Journal

Authors：

1 Department of General Surgery, Chengdu Railway Central Hospital, Chengdu Sichuan 610081 China; 2 Department of General Surgery, Chengdu 10th People’s Hospital, Chengdu Sichuan 610061;

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Keywords：

肝硬化; 膽囊結石; 膽囊切除術,腹腔鏡

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目的:探討腹腔鏡膽囊切除術對膽囊結石合并肝硬化的圍手術期影響及技術特點。方法:回顧分析80例膽囊結石合并肝硬化患者行腹腔鏡膽囊切除術(LC)、開腹膽囊切除術(OC)前后肝功能、凝血功能及術中出血量、手術時間、術后住院時間、術后禁食時間等臨床資料并比較兩組間差異。結果:全組無死亡、術后肝功能衰竭、膽道損傷、膽漏等嚴重并發癥病例。手術及麻醉對肝功能、凝血功能的影響在LC、OC兩組間比較差異無顯著意義(P gt;0.05)。LC組在手術時間、術中出血量、術后禁食時間、術后住院時間等指標方面優于OC組,兩組間差異有顯著意義(P lt;0.05)。結論:與OC比較,膽囊結石合并肝硬化行LC是安全的,并且有著微創、術后恢復快等優勢,關鍵是掌握手術的技術特點、注重Child-push分級及圍手術期的處理。

Citation： YUAN Jiatian,WEI Guo,WEN Xianmin,et al.. Application of Laparoscopic Cholecystectomy in the Therapy of Cholelithiasis Associated with Liver Cirrhosis. West China Medical Journal, 2009, 24(7): 1649-1651. doi: Copy

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2.	POGGIO J L, Acomparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease[J].Surgery, 2000,127:405-411.
3.	URBAN L, EASON G A, REMINE S, et al．Laparoscopic cholecystectomy in patients with early cirhosis[J]．Cur Surg,2001,58(3):312-315.
4.	中華醫學會肝病學分會、傳染病與寄生蟲病學分會修訂.病毒性肝炎防治方案[J].中華肝臟病雜志,2000,8(6):324.
5.	BOMMAN P C, TERBLANCHE J. Subtotal cholecystectomy: For the dificult gallbladder in portal hypertension and cholecystitis[J]．Surgery,1985,98(1):1-6.
6.	嵇武,李令堂,汪志明,等. 肝硬化門靜脈高壓患者腹腔鏡與膽囊切除術的隨機對照研究[J]．中華消化內鏡雜志,2004,21(5):337-339.
7.	HALERY A, GOLDDENTCH R, NEYRI M, et al．Are elevated liver enzymes and bilirubin levels significant after LC in the absence ofbile duct injury[J]．Ann Surgy,1994,219:362-364.
8.	周群,鄧明,彭立勛等.腹腔鏡膽囊切除術治療膽囊結石合并肝硬化的臨床對照觀察[J]. 肝膽外科雜志,2000,8(1):58-59.
9.	陳新剛.肝硬化合并膽囊結石行腹腔鏡與開腹膽囊切除手術療效比較[J]. 中原醫刊,2007,34(l4)58-59.

1. 魏國,何敏,范合璋等.肝炎后肝硬化合并膽囊結石的臨床分析[J].中國實用醫藥雜志,2006,1(4):41-42.
2. POGGIO J L, Acomparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease[J].Surgery, 2000,127:405-411.
3. URBAN L, EASON G A, REMINE S, et al．Laparoscopic cholecystectomy in patients with early cirhosis[J]．Cur Surg,2001,58(3):312-315.
4. 中華醫學會肝病學分會、傳染病與寄生蟲病學分會修訂.病毒性肝炎防治方案[J].中華肝臟病雜志,2000,8(6):324.
5. BOMMAN P C, TERBLANCHE J. Subtotal cholecystectomy: For the dificult gallbladder in portal hypertension and cholecystitis[J]．Surgery,1985,98(1):1-6.
6. 嵇武,李令堂,汪志明,等. 肝硬化門靜脈高壓患者腹腔鏡與膽囊切除術的隨機對照研究[J]．中華消化內鏡雜志,2004,21(5):337-339.
7. HALERY A, GOLDDENTCH R, NEYRI M, et al．Are elevated liver enzymes and bilirubin levels significant after LC in the absence ofbile duct injury[J]．Ann Surgy,1994,219:362-364.
8. 周群,鄧明,彭立勛等.腹腔鏡膽囊切除術治療膽囊結石合并肝硬化的臨床對照觀察[J]. 肝膽外科雜志,2000,8(1):58-59.
9. 陳新剛.肝硬化合并膽囊結石行腹腔鏡與開腹膽囊切除手術療效比較[J]. 中原醫刊,2007,34(l4)58-59.

West China Medical Journal

Application of Laparoscopic Cholecystectomy in the Therapy of Cholelithiasis Associated with Liver Cirrhosis

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