Wang Ming-Jun, Li Jun-Li, Zhou Jin, Wu Zhong, Peng Bing
Ming-Jun Wang, Zhong Wu, Bing Peng, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2014 Jan 14;20(2):546-54. doi: 10.3748/wjg.v20.i2.546.
To evaluate the feasibility, safety, and effectiveness of consecutive laparoscopic cholecystectomy (LC) plus splenectomy (LS) in liver cirrhosis patients.
From 2003 to 2013, 17 (group 1) patients with liver cirrhosis complicated by hypersplenism and symptomatic gallstones were treated with combined LC and LS, while 58 (group 2) patients with liver cirrhosis and hypersplenism received LS alone. An additional 14 (group 3) patients who received traditional open procedures during the same period were included as controls. Data were retrospectively collected and reviewed in regard to demographic characteristics and preoperative, intraoperative and postoperative features. Differences between the three groups were assessed by statistical analysis.
The three groups showed no significant differences in the demographic characteristics or preoperative status. However, the patients treated with LC and LS required significantly longer operative time, shorter postoperative stay as well as shorter time of return to the first oral intake, and suffered less intraoperative blood loss as well as fewer postoperative surgical infections than the patients treated with traditional open procedures (group 1 vs group 3, P < 0.05 for all). The patients treated with LC and LS showed no significant differences in the intraoperative and postoperative variables from those treated with LS alone (group 1 vs group 2). All patients showed significant improvements in the haematological responses (preoperative period vs postoperative period, P < 0.05 for all). None of the patients treated with LC and LS presented with any gallstone-associated symptoms following discharge, while the patients treated with the traditional open procedures expressed complaints of discomfort related to their surgical incisions.
Consecutive LC and LS is an appropriate treatment option for liver cirrhosis patients with gallstones and hypersplenism, especially for those with Child-Pugh A and B.
评估连续腹腔镜胆囊切除术（LC）联合脾切除术（LS）治疗肝硬化患者的可行性、安全性和有效性。
2003年至2013年，17例（第1组）肝硬化合并脾功能亢进和有症状胆结石的患者接受了LC联合LS治疗，而58例（第2组）肝硬化合并脾功能亢进的患者仅接受了LS治疗。另外纳入同期接受传统开放手术的14例（第3组）患者作为对照。回顾性收集并分析了人口统计学特征以及术前、术中和术后特征的数据。通过统计分析评估三组之间的差异。
三组在人口统计学特征或术前状态方面无显著差异。然而，与接受传统开放手术的患者相比，接受LC和LS治疗的患者手术时间明显更长，术后住院时间更短，首次恢复经口进食的时间更短，术中失血量更少，术后手术感染更少（第1组与第3组相比，所有指标P<0.05）。接受LC和LS治疗的患者与仅接受LS治疗的患者在术中和术后变量方面无显著差异（第1组与第2组）。所有患者的血液学反应均有显著改善（术前与术后相比，所有指标P<0.05）。接受LC和LS治疗的患者出院后均未出现任何与胆结石相关的症状，而接受传统开放手术的患者则表示有手术切口相关的不适主诉。
连续LC和LS是肝硬化合并胆结石和脾功能亢进患者的合适治疗选择，尤其是Child-Pugh A级和B级患者。
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