Meshikhes A N, al-Dhurais S A, al-Jama A, al-Faraj A A, al-Khatir N S, al-Abkar H
Department of Surgery, Dammam Central Hospital, Saudi Arabia.
J R Coll Surg Edinb. 1995 Dec;40(6):383-5.
Over a year (October 1992-September 1993), 30 patients (23 males and 7 females) with sickle cell anaemia and symptomatic gallstones underwent laparoscopic cholecystectomy (LC). The mean age was 26 years (range 15-44 years). The indications were: acute cholecystitis in four patients and long-standing biliary colic in the other 26. Twenty-four patients (80%) had a previous history of abdominal sickle cell crises. The preoperative HbF and HbS levels ranged from 18 to 33% and from 66 to 77.2%, respectively. The haemoglobin level ranged from 8.6 to 12 g% (mean 9.7 g%). Blood transfusion was given preoperatively to 19 patients (63%) and three patients needed perioperative transfusion. The mean operative time was 75 min (range 60-100 min). One of the four emergency cases was converted to open cholecystectomy due to difficult anatomy and inability to grasp a thick-walled, distended gallbladder. Two patients developed minor chest infections and one had an acute vaso-occlusive crisis on the fifth postoperative day and died despite the appropriate treatment (morbidity 6.6%, mortality 3.3%). The median hospital stay was 2 days (range 1-5 days). We believe that LC can be conducted safely in sickle cell patients with gallstones with minimal morbidity and mortality.
在一年时间里（1992年10月至1993年9月），30例患有镰状细胞贫血且有症状性胆结石的患者（23例男性和7例女性）接受了腹腔镜胆囊切除术（LC）。平均年龄为26岁（范围15 - 44岁）。手术指征为：4例急性胆囊炎，其余26例为长期胆绞痛。24例患者（80%）有腹部镰状细胞危象病史。术前HbF和HbS水平分别为18%至33%和66%至77.2%。血红蛋白水平为8.6至12 g%（平均9.7 g%）。19例患者（63%）术前接受了输血，3例患者围手术期需要输血。平均手术时间为75分钟（范围60 - 100分钟）。4例急诊病例中有1例因解剖结构困难且无法抓住厚壁、扩张的胆囊而转为开腹胆囊切除术。2例患者发生轻微肺部感染，1例在术后第5天发生急性血管闭塞危象，尽管进行了适当治疗仍死亡（发病率6.6%，死亡率3.3%）。中位住院时间为2天（范围1 - 5天）。我们认为，对于患有胆结石的镰状细胞病患者，腹腔镜胆囊切除术可以安全进行，发病率和死亡率极低。
