Xu Qing, Gu Lei, Wu Zhi-Yong
Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Hepatobiliary Pancreat Dis Int. 2007 Oct;6(5):479-82.
Liver cirrhosis and cholelithiasis are both familiar diseases in China. However, the rates of operative complications and death are still high in patients with these diseases. This study was designed to determine the operative indications as well as suitable procedures in the treatment of patients with cholelithiasis and liver cirrhosis.
We studied retrospectively 60 patients with cholelithiasis and liver cirrhosis who had undergone operation from January 2000 to July 2006. We analyzed the loss of blood during operation, postoperative complications and death rate to determine the proper treatment.
Fifty patients were cured and 10 (16.7%) died postoperatively, i.e., six patients died from hepatic-renal failure and multisystem organ dysfunction and 4 from massive bleeding in the gallbladder bed. The 10 patients were clearly correlated with the Child-Pugh classification: Child A (8%), Child B (20%) and Child C (30%). Postoperative bleeding occurred in 10 patients (16.7%), intraabdominal in 6 and gastrointestinal in 4. Seven of the 10 patients with bleeding died postoperatively.
The proper perioperative management of patients with cholelithiasis and liver cirrhosis can decrease the mortality. Cholelithiasis should be managed first by emergency operation. It is safe for the patients of Child A to undergo laparoscopy. It is very safe for patients with cirrhosis and cholelithiasis to undergo devascularization and shunt operation followed by biliary tract surgery.
肝硬化和胆石症在中国均为常见疾病。然而，这些疾病患者的手术并发症发生率和死亡率仍然很高。本研究旨在确定胆石症合并肝硬化患者的手术适应证及合适的手术方式。
我们回顾性研究了2000年1月至2006年7月期间接受手术的60例胆石症合并肝硬化患者。分析手术中的失血量、术后并发症及死亡率，以确定合适的治疗方法。
50例患者治愈，10例（16.7%）术后死亡，即6例死于肝肾衰竭和多系统器官功能障碍，4例死于胆囊床大出血。这10例患者与Child-Pugh分级明显相关：Child A级（8%）、Child B级（20%）和Child C级（30%）。术后出血发生在10例患者（16.7%）中，腹腔内出血6例，胃肠道出血4例。10例出血患者中有7例术后死亡。
对胆石症合并肝硬化患者进行适当的围手术期管理可降低死亡率。胆石症应首先通过急诊手术治疗。Child A级患者行腹腔镜手术是安全的。肝硬化合并胆石症患者先进行去血管化分流手术，然后再进行胆道手术是非常安全的。
