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腹腔镜手术治疗胆囊结石伴肝硬化的疗效观察 预览 被引量:10

Clinical observation of laparoscopic treatment of gallstone patients with cirrhosis
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摘要 目的探讨胆囊结石伴肝硬化患者行腹腔镜胆囊切除术(LC)的可行性及临床疗效。方法回顾性分析收治的105例胆囊结石伴肝硬化患者的临床资料。患者分成LC组(54例)和开腹胆囊切除术(OC)组(51例),比较并分析两组间的手术时间、术中出血量、术后住院时间、总费用、术后并发症,肝功能的术前术后变化等指标;统计术后并发症的发生率,分析其发生的相关危险因素。结果与OC组比较,LC组的手术时间[52.5(35-150)min vs 70(45-150)min]少、住院时间[(3.9±2.9)d vs(9.5±4.8)d]更短,术中出血量[50(20-280)ml vs 75(30-500)ml]更少,肝功能、肝功能Child-Pugh评分术前术后的变化更小,差异均有统计学意义(P〈0.05)。术后并发症(11%vs18%)、肝功能Child-Pugh分级术前术后的改变,两组间差异无统计学意义(P〉0.05)。肝功能ChildPugh分级、术前腹腔积液与胆囊结石伴肝硬化患者行胆囊切除术后并发症的发生有关(P〈0.05),术前腹腔积液(OR=10.258,95%CI 1.364-77.146,P=0.024)是术后发生并发症的独立危险因素。结论胆囊结石伴肝硬化患者(肝功能Child-Pugh A、B级)行LC是安全可行的;与OC相比,其具有术中手术时间短、术中出血少、术后住院时间短、对肝功能影响小的优势;此类患者行胆囊切除术后并发症的出现与术前腹腔积液密切相关。 Objective To investigate the feasibility and benefits of laparoscopic cholecystectomy (LC)in cirrhotic patients with cholecystolithiasis. Methods The clinical data of 105 cases of cholecystolithiasis associated with liver cirrhosis were retrospectively analyzed. All patients were divided into laparoscopic cholecystectomy group (n =54) and open cholecystectomy group ( n =51). The two groups were com-pared regarding operative time, blood loss, surgical complications, postoperative liver function, postoperative hospital stay and hospital costs. The incidence rate of the complications and the risk factors for the complications were also analyzed. Results As compared with open cholecystectomy group, the operative time [5 2 . 5 (35-150) min vs 70( 45- 150) min ] and postoperative hospital stay [ ( 3. 9 ± 2. 9) days vs ( 9 . 5 ± 4.8) days] were shorter, blood loss was less [50(20-280)ml vs 75(30 -500)m l ] , and the changes of liver function and Child-Pugh score were milder in laparoscopic cholecystectomy group. The differences were sta-tistically significant ( P 〈0.05). But the differences in postoperative complications and the change of Child- Pugh class between two groups were not significant ( P 〉 0 .05). According to the univariate analysis, the ChildPugh class and preoperative ascites were risks factors for the postoperative complications ( P〈0. 05 ). Further analysis using multiple logistic regression illustrated that preoperative ascites was independent risk factor for the postoperative complications ( OR = 10.258 , 95% Cl 1.364-77. 146 , P = 0 .024) . Conclusions Laparoscopic cholecystectomy is an effective and safe treatment for symptomatic gallstone disease in patients with Child-Pugh A and B cirrhosis. The advantages over open cholecystectomy are the shorter operative time and postoperative hospital stay, the less blood less and the milder effect on liver function. The occu
作者 桂亮 刘晔 秦骏 郑磊 钱彬彬 黄毅军 罗蒙 Gui Liang , Liu Ye , Qin Jun , Zheng Lei, Qian Bin bin ,Huang Yijun,Luo Meng( 1. Department of General Su rg e ry , Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine. Shanghai 201999, China ; Department of General Su rg e ry , Ren Ji Hospital S ha ng h ai Jiao Tong University School of Medicine. Shanghai 200127, China)
出处 《中华腔镜外科杂志(电子版)》 2016年第3期175-179,共5页
基金 上海市宝山区科委项目(13-E-4)
关键词 胆囊结石 肝硬化 腹腔镜胆囊切除术 Cholecystolithiasis Liver cirrhosis Laparoscopic cholecystectomy
作者简介 桂亮(1989-),硕士研究生在读,主要从事普外疾病的微创研究 通讯作者:罗蒙,Email:luotysy@sina.com
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