Târcoveanu Eugen, Vasilescu Alin, Lupaşcu Cristian, Vlad Nutu, Moraru Marius, Stanciu Carol, Bejan Valentin, Bradea Costel
Chirurgia (Bucur). 2020 Mar-Apr;115(2):213-219. doi: 10.21614/chirurgia.115.2.213.
Laparoscopic cholecystectomy is the gold standard procedure in patients with cirrhosis and symptomatic gallbladder disease or acute cholecystitis. In this retrospective study we evaluated laparoscopic cholecystectomy in patients with cirrhosis based on Child-Pugh score as a predictor of morbidity. In the First Surgical Clinic of Iasi, from 01 jan 2010 to 31 jan 2020, we performed 111 laparoscopic cholecystectomies in Child-Pugh A, B, and C cirrhotic patients. Intraoperative difficulty (grade 3 Cuschieri) was experienced in 32 patients (28.8%). Highly vascular sub hepatic adherences have been reported in a quarter of all patients. Intraoperative incidents were more frequent 27 (24.3%) compared to laparoscopic cholecystectomy performed in other patient groups. The conversion rate to open cholecystectomy was 6.3% (7 cases). Mean operative time was 84 min. Mean duration of hospitalization stay was 4.7 days. The morbidity rate was 16.2% of patients and included bleeding, intraabdominal fluid collections and wound complications more common in patients with Child-Pugh Cirrhosis B and C. The results are dependent of the perioperative management of the liver function.
腹腔镜胆囊切除术是肝硬化合并有症状胆囊疾病或急性胆囊炎患者的金标准手术。在这项回顾性研究中，我们基于Child-Pugh评分评估了肝硬化患者行腹腔镜胆囊切除术的发病情况预测因素。在雅西第一外科诊所，从2010年1月1日至2020年1月31日，我们对Child-Pugh A级、B级和C级肝硬化患者进行了111例腹腔镜胆囊切除术。32例患者（28.8%）术中出现困难（Cuschieri 3级）。四分之一的患者报告有高度血管化的肝下粘连。与其他患者组进行的腹腔镜胆囊切除术相比，术中事件更频繁，有27例（24.3%）。转为开腹胆囊切除术的比例为6.3%（7例）。平均手术时间为84分钟。平均住院时间为4.7天。发病率为患者的16.2%，包括出血、腹腔积液和伤口并发症，在Child-Pugh B级和C级肝硬化患者中更常见。结果取决于肝功能的围手术期管理。
