Shaikh Abdul Razaque, Muneer Ambreen
Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan.
JSLS. 2009 Oct-Dec;13(4):592-6. doi: 10.4293/108680809X12589999537959.
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.
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.
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.
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.
肝硬化患者患胆结石的几率是普通人群的两倍。尽管腹腔镜胆囊切除术（LC）已成为有症状胆结石的金标准治疗方法，但肝硬化一直被视为绝对或相对禁忌症。许多作者报道了LC在肝硬化患者中的安全性。我们对患者进行了回顾性研究，并评估了巴基斯坦一家三级护理医院中LC在肝硬化患者中的安全性。
2003年1月至2005年12月，在贾姆肖罗的利亚卡特医科大学健康科学学院第四分院进行了一项回顾性研究。所有接受Child-Pugh A级和B级肝硬化的LC手术的肝硬化患者均纳入研究。肝硬化根据临床、生化、超声检查以及术中肝脏结节和组织病理学研究结果进行诊断。
在250例行腹腔镜胆囊切除术的患者中，20例（12.5%）为肝硬化患者。在这20例患者中，12例（60%）为Childs A组，8例（40%）为B组。30%为乙肝阳性，70%为丙肝阳性。80%的病例术前可诊断出肝硬化，20%在手术中诊断出。发病率为15%，死亡率为0%。两名患者术后出现腹水，平均住院时间为2.8±0.1天。在20例病例中，2例（10%）转为开腹胆囊切除术。平均手术时间为70.2±32.54分钟。
腹腔镜胆囊切除术对于Child-Pugh A级和B级肝硬化的特定患者的有症状胆结石疾病是一种有效且安全的治疗方法。与开腹胆囊切除术相比，其优势在于发病率较低且住院时间缩短。
