da Silveira Eduardo B V
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
J Gastroenterol Hepatol. 2006 Jun;21(6):958-62. doi: 10.1111/j.1440-1746.2006.04227.x.
Cholelithiasis is a common finding in patients with cirrhosis. Previous studies showed that open cholecystectomy (OC) carries a high risk of postoperative complications and deaths in cirrhotic patients. Laparoscopic cholecystectomy (LC) has significantly decreased hospital stay and postoperative morbidity in non-cirrhotic patients. The aim of this study was to evaluate the outcomes of cirrhotic patients after LC and OC in a tertiary center.
The outcomes of 33 cirrhotic patients matched by age and sex to 66 non-cirrhotic controls who underwent cholecystectomy were assessed using Bayesian analysis. Both non-informative and informative priors were used to calculate posterior distributions for parameters under investigation.
Twenty-four (72%) cirrhotic patients had LC and 9 (27%) OC. A similar percentage of patients in the control group underwent LC (78%) and OC (21%). Emergent cholecystectomy was not different between cirrhotic and controls (95% credible interval [CrI]-0.35, 0.02). Mean blood loss, duration of surgery and conversion rate was not different between cirrhotic and controls, but cirrhotic patients had a longer length of hospital stay than controls (CrI 0.88, 4.71). Cirrhotic patients undergoing LC had lower volume of blood loss (CrI -363.85 mL, -49.28 mL), shorter duration of surgery (CrI -79.82 min, -19.74 min), lower amount of intravenous fluid during surgery (CrI -1532.9 mL, -495.4 mL) and shorter hospital stay (CrI -11.14 days, -1.20 days) than cirrhotic patients undergoing OC. Child-Pugh class B class and admission diagnosis of biliary pancreatitis were associated with a longer hospital stay.
Laparoscopic cholecystectomy is a safe and effective alternative to OC in Child-Pugh class A and B cirrhotic patients undergoing elective or emergent cholecystectomy. Although outcomes of cirrhotic patients undergoing LC and OC in a tertiary center are not different, LC is associated with less intraoperative bleeding, shorter duration of surgery and fewer days of in-hospital care.
胆结石在肝硬化患者中很常见。既往研究表明，开腹胆囊切除术（OC）在肝硬化患者中术后并发症和死亡风险较高。腹腔镜胆囊切除术（LC）显著缩短了非肝硬化患者的住院时间和术后发病率。本研究的目的是评估在三级中心肝硬化患者接受LC和OC后的结局。
采用贝叶斯分析评估33例年龄和性别匹配的肝硬化患者及66例接受胆囊切除术的非肝硬化对照者的结局。使用非信息先验和信息先验来计算所研究参数的后验分布。
24例（72%）肝硬化患者接受了LC，9例（27%）接受了OC。对照组中接受LC（78%）和OC（21%）的患者比例相似。肝硬化患者和对照组之间急诊胆囊切除术无差异（95%可信区间[CrI]-0.35，0.02）。肝硬化患者和对照组之间平均失血量、手术时间和中转率无差异，但肝硬化患者住院时间比对照组更长（CrI 0.88，4.71）。与接受OC的肝硬化患者相比，接受LC的肝硬化患者失血量更少（CrI -363.85 mL，-49.28 mL）、手术时间更短（CrI -79.82分钟，-19.74分钟）、术中静脉输液量更少（CrI -1532.9 mL，-495.4 mL）且住院时间更短（CrI -11.14天，-1.20天）。Child-Pugh B级和胆源性胰腺炎入院诊断与住院时间延长有关。
对于接受择期或急诊胆囊切除术的Child-Pugh A级和B级肝硬化患者，腹腔镜胆囊切除术是开腹胆囊切除术的一种安全有效的替代方法。虽然三级中心接受LC和OC的肝硬化患者结局无差异，但LC与术中出血更少、手术时间更短和住院天数更少相关。
