Zuiki Toru, Ohki Jun, Horiuchi Toshio, Lefor Alan Kawarai, Shirakata Fuyumi, Hirota Yuka, Hirota Norio
Department of Surgery, Yuki Hospital, Yuki 9629-1, Yuki City, Ibaraki, Japan.
Department of Surgery, Yuki Hospital, Yuki 9629-1, Yuki City, Ibaraki, Japan.
Int J Surg Case Rep. 2020;67:45-50. doi: 10.1016/j.ijscr.2020.01.028. Epub 2020 Jan 27.
Laparoscopic cholecystectomy for patients with acute cholecystitis and liver cirrhosis is associated with increased risk. We present an obese patient with acute cholecystitis and liver cirrhosis caused by nonalcoholic steatohepatitis (NASH), who was successfully managed with laparoscopic cholecystostomy and a low-carbohydrate diet with exercise.
A 61-year-old woman presented with right upper quadrant abdominal pain. Ultrasonography and computed tomography were consistent with acute cholecystitis with multiple stones and cirrhosis. The patient had no history of alcohol intake, and serologic tests were negative. The patient's body mass index was 39 kg/m (154 cm, 93 kg) and NASH was suspected. Percutaneous transhepatic drainage was impossible because of the anatomic position of the gallbladder. Emergency laparoscopic cholecystostomy was performed initially for drainage. A low-carbohydrate diet and exercise were started for weight loss and her weight reduced by 19 kg over three months. Open cholecystectomy was performed uneventfully, and liver biopsy suggested NASH.
Laparoscopic cholecystostomy is a reasonable temporary alternative to cholecystectomy in patients with acute cholecystitis and increased surgical risk. Weight loss with diet and exercise can be effective in patients with NASH. A low-carbohydrate diet is a reasonable treatment for NASH, because glucose is converted to triglycerides and stored as lipid in the liver.
Laparoscopic cholecystostomy was effective in this obese patient with acute cholecystitis and NASH cirrhosis. Using a low-carbohydrate diet with exercise, her weight decreased, and subsequent open cholecystectomy was uneventful.
对患有急性胆囊炎和肝硬化的患者进行腹腔镜胆囊切除术会增加风险。我们报告一例肥胖患者，其患有由非酒精性脂肪性肝炎（NASH）引起的急性胆囊炎和肝硬化，通过腹腔镜胆囊造口术以及低碳水化合物饮食加运动成功得到治疗。
一名61岁女性因右上腹疼痛就诊。超声检查和计算机断层扫描结果显示符合急性胆囊炎伴多发结石及肝硬化。该患者无饮酒史，血清学检查为阴性。患者体重指数为39kg/m²（身高154cm，体重93kg），怀疑患有NASH。由于胆囊的解剖位置，无法进行经皮肝穿刺引流。最初进行了急诊腹腔镜胆囊造口术以引流。开始采用低碳水化合物饮食和运动来减轻体重，三个月内她的体重减轻了19kg。随后顺利进行了开腹胆囊切除术，肝脏活检提示为NASH。
对于急性胆囊炎且手术风险增加的患者，腹腔镜胆囊造口术是胆囊切除术合理的临时替代方案。饮食和运动减肥对NASH患者可能有效。低碳水化合物饮食是治疗NASH的合理方法，因为葡萄糖会转化为甘油三酯并作为脂质储存在肝脏中。
腹腔镜胆囊造口术对这名患有急性胆囊炎和NASH肝硬化的肥胖患者有效。通过采用低碳水化合物饮食加运动，她的体重下降，随后的开腹胆囊切除术也顺利进行。
