Vecchio R, Cacciola E, Murabito P, Gambelunghe A V, Murabito R, Cacciola R R, Di Martino M
Department of Surgery, University of Catania.
G Chir. 2001 Jan-Feb;22(1-2):45-8.
Cholecystectomy is a common surgical procedure performed in patients with sickle cell disease (SCD). Postoperative complications, including acute painful vaso-occlusive crisis and acute chest syndrome, have been described frequently after either traditional or laparoscopic cholecystectomy (LC). It's still not clear if preoperative blood transfusion, hyperhydration, intraoperative body temperature conservation may reduce complications rate. The Authors reviewed the charts of seven patients with SCD operated on LC for symptomatic gallbladder lithiasis and describe their perioperative management. In 3 patients preoperative endoscopic removal of stones was achieved. Five patients with HB lower than 9 g/dl and/or HbS higher than 40% were transfused preoperatively and all the patients were hyperhydrated. Intraoperative monitoring was achieved for early recognition of ventilation to perfusion mismatch and acid-base balance or temperature modifications. The Authors reported only one case of postoperative lower extremities pain. This study suggests that LC is a safe procedure in SCD if appropriate monitoring and perioperative management are achieved.
胆囊切除术是镰状细胞病（SCD）患者中常见的外科手术。传统或腹腔镜胆囊切除术（LC）后，术后并发症，包括急性疼痛性血管闭塞危象和急性胸综合征，经常被报道。术前输血、补液以及术中体温维持是否可降低并发症发生率仍不明确。作者回顾了7例因有症状的胆囊结石接受LC手术的SCD患者的病历，并描述了他们的围手术期管理。3例患者术前通过内镜取出结石。5例血红蛋白低于9 g/dl和/或镰状血红蛋白高于40%的患者术前接受了输血，所有患者均进行了补液。术中进行监测以早期识别通气与灌注不匹配以及酸碱平衡或体温变化。作者仅报告了1例术后下肢疼痛病例。这项研究表明，如果进行适当的监测和围手术期管理，LC在SCD患者中是一种安全的手术。
