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肝硬化患者的腹腔镜胆囊切除术

Laparoscopic cholecystectomy in cirrhotic patients.

作者信息

D'Albuquerque L A, de Miranda M P, Genzini T, Copstein J L, de Oliveira e Silva A

机构信息

Liver Therapy Center (CETEFI), Hospital Beneficência, Portuguesa, São Paulo, Brazil.

出版信息

Surg Laparosc Endosc. 1995 Aug;5(4):272-6.

PMID:7551278
Abstract

Cholecystectomy in cirrhotic patients is commonly followed by high morbidity and mortality. In our study, laparoscopic cholecystectomy was performed in 12 cirrhotic patients (eight Child A and four Child B) in an effort to obtain lower complication and mortality rates. The mean age of the group was 51.8 years; seven of the 12 patients were men. Four patients had liver disease from virus B, five from virus C, one because of alcohol, and two had cryptogenic liver cirrhosis. The average operative time was 157 min. Intraoperative cholangiography could be performed in eight cases. No mortality or need to perform laparotomy occurred. Only one patient required blood transfusion (8.3%). Postoperative complications occurred in four patients, but these were easily controlled and included renal failure, diabetic impairment, hematoma with ascitic leakage through the wound, and wound abscess, one case each. No postoperative liver failure was observed. All patients walked and were refed in the first 24 h after surgery. They were dismissed in an average period of 2.5 days. Our primary view demonstrated that laparoscopic cholecystectomy was safe and well tolerated by selected cirrhotic patients (Child A and B) with clear indication for surgery.

摘要

肝硬化患者行胆囊切除术后通常会出现较高的发病率和死亡率。在我们的研究中,对12例肝硬化患者(8例Child A级和4例Child B级)进行了腹腔镜胆囊切除术,以期获得较低的并发症和死亡率。该组患者的平均年龄为51.8岁;12例患者中有7例为男性。4例患者因乙型病毒感染患有肝病,5例因丙型病毒感染,1例因酒精性肝病,2例为隐源性肝硬化。平均手术时间为157分钟。8例患者可行术中胆管造影。未发生死亡或需要开腹手术的情况。仅1例患者需要输血(8.3%)。4例患者出现术后并发症,但均易于控制,包括肾衰竭、糖尿病损害、伤口血肿伴腹水渗漏和伤口脓肿,各1例。未观察到术后肝衰竭。所有患者术后24小时内即可行走并恢复进食。他们平均在2.5天后出院。我们的初步观察表明,对于有明确手术指征的特定肝硬化患者(Child A级和B级),腹腔镜胆囊切除术是安全的且耐受性良好。

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