肝硬化患者腹腔镜胆囊切除术

肝硬化患者腹腔镜胆囊切除术

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摘要：
背景与目的：胆结石的两倍，在一般人群中常见的肝硬化患者。虽然腹腔镜胆囊切除术（LC）已成为有症状的胆囊结石的金标准，肝硬化一直被认为是绝对的或相对的禁忌。许多作者报道LC在肝硬化患者中的安全性。我们回顾和检讨我们的病人，在肝硬化患者中的安全性进行评估的LC三级保健医院在巴基斯坦。
方法： 2003年1月2005年12月，一项回顾性研究进行在SU IV，Liaquat大学医学与健康科学贾姆肖罗。所有被列入肝硬化患者Child-Pugh分级A和B级肝硬化发生LC的研究。肝硬化的诊断依据临床，生化，超声，术中发现的结节状肝组织病理学研究。
结果： 250例腹腔镜胆囊切除术，20例（12.5％），肝硬化。这20个中，有12（60％）童车组A和8（40％），B组有百分之三十是乙肝大三阳，70％的丙肝阳性。术前诊断为肝硬化有可能在80％的情况下，在手术过程中，20％被确诊。发病率为15％，死亡率为0％。2例患者术后腹水，平均住院天数为2.8±0.1天。20例中，有2例（10％）转换为开腹胆囊切除术。平均手术时间为70.2±32.54分钟。
结论：在选择Child-Pugh分级A和B肝硬化患者腹腔镜胆囊切除术是一种有效和安全的治疗胆石病症状。开腹胆囊切除术的优点是降低发病率和减少住院。

Laparoscopic Cholecystectomy in Cirrhotic Patients

Abstract:
Background and Objectives: Gallstones are twice as common in cirrhotic patients as in the general population. Although laparoscopic cholecystectomy (LC) has become the gold standard for symptomatic gallstones, cirrhosis has been considered an absolute or relative contraindication. Many authors have reported on the safety of LC in cirrhotic patients. We reviewed our patients retrospectively and assessed the safety of LC in cirrhotic patients at a tertiary care hospital in Pakistan.
Methods: From January 2003 to December 2005, a retrospective study was conducted at SU IV, Liaquat University of Medical & Health Sciences Jamshoro. All the cirrhotic patients with Child-Pugh class A and B cirrhosis undergoing LC were included in the study. Cirrhosis was diagnosed based on clinical, biochemical, ultrasonography, and intraoperative findings of the nodular liver and histopathological study.
Results: Of 250 patients undergoing laparoscopic cholecystectomy, 20 (12.5%) were cirrhotic. Of these 20, 12 (60%) were Childs group A and 8 (40%) were group B. Thirty percent were hepatitis B positive, and 70% were hepatitis C positive. Preoperative diagnosis of cirrhosis was possible in 80% of cases, and 20% were diagnosed during surgery. Morbidity rate was 15% and mortality rate was 0%. Two patients developed postoperative ascites, and mean hospital stay was 2.8±0.1 days. Of the 20 cases, 2 (10%) were converted to open cholecystectomy. The mean operation time was 70.2±32.54 minutes.
Conclusion: Laparoscopic cholecystectomy is an effective and safe treatment for symptomatic gallstone disease in select patients with Child-Pugh A and B cirrhosis. The advantages over open cholecystectomy are the lower morbidity rate and reduced hospital stay.