Bloch R S, Allaben R D, Walt A J
Arch Surg. 1985 Jun;120(6):669-72. doi: 10.1001/archsurg.1985.01390300019003.
Cholecystectomy or cholecystostomy was performed in 49 patients with cirrhosis with a mortality of 10.2%. Massive intraoperative blood loss was found in 16.3% and major wound problems (dehiscence, abscess) in 12.2%. Intraoperative blood loss, amount of blood transfused, and mortality were correlated with the Child classification of hepatic reserve. Mortality was 23.5% for Child C patients vs 0% for Child A patients. Excessive blood loss from a hypervascular biliary bed and resulting liver failure and sepsis were the usual causes of death. Elective surgical intervention for Child A and B patients with symptomatic cholelithiasis is warranted. In Child C patients, however, every attempt should be made to increase the class to a Child B.
49例肝硬化患者接受了胆囊切除术或胆囊造瘘术，死亡率为10.2%。16.3%的患者术中出现大量失血，12.2%的患者出现严重伤口问题（裂开、脓肿）。术中失血量、输血量和死亡率与肝脏储备的Child分级相关。Child C级患者的死亡率为23.5%，而Child A级患者为0%。血管丰富的胆管床失血过多以及由此导致的肝衰竭和败血症是常见的死亡原因。对于有症状胆石症的Child A级和B级患者，进行择期手术干预是必要的。然而，对于Child C级患者，应尽一切努力将其分级提升至Child B级。
