Vasincu D, Mihalache St, Bogza Geanina
Clinica de Chirurgie, Spitalul Clinic de Urgenţe "Sf. Ioan" Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2008 Jul-Sep;112(3):669-72.
Cholecystectomy in cirrhotic patients has been reserved for patients with severe biliary disease, because of the high morbidity and mortality in cirrhotic patients undergoing this procedure. Laparoscopic cholecystectomy (LC) was originally contraindicated in cirrhotic patients because of the associated portal hypertension and coagulopathy.
This study examined the safety of LC in Child's class A patients and acute cholecystitis due to cholelithiasis in patients from "Sf. Ioan" Emergency Hospital Iaşi. The studied period was January 2001 - December 2005. Ten patients with cirrhosis had their gallbladder removed laparoscopically during that time period. All patients were Child's class A.
The average age was 62,5 (range, 56-68). The operative indication was acute cholecystitis. Three patients were previously diagnosed with cirrhosis, and 7 were diagnosed intraoperatively. None of the patients required a blood transfusion. No intraoperative or postoperative complications occurred. No deaths occurred. Postoperative stay was 5.8 days. These results compare favorably to other published studies from international literature.
Based on our findings, we believe LC can be performed safely in patients with class A cirrhosis.
由于肝硬化患者进行胆囊切除术的发病率和死亡率较高,该手术一直仅用于患有严重胆道疾病的患者。由于存在相关的门静脉高压和凝血功能障碍,腹腔镜胆囊切除术(LC)最初被列为肝硬化患者的禁忌。
本研究探讨了在雅西“圣约安”急诊医院对Child A级患者进行LC以及对因胆结石导致急性胆囊炎患者进行LC的安全性。研究时间段为2001年1月至2005年12月。在此期间,10例肝硬化患者接受了腹腔镜胆囊切除术。所有患者均为Child A级。
平均年龄为62.5岁(范围56 - 68岁)。手术指征为急性胆囊炎。3例患者先前被诊断为肝硬化,7例在术中被诊断出。所有患者均未输血。未发生术中或术后并发症。无死亡病例。术后住院时间为5.8天。这些结果优于国际文献中其他已发表的研究。
基于我们的研究结果,我们认为LC可在Child A级肝硬化患者中安全进行。