论文部分内容阅读
目的:探讨腹腔镜胆囊切除术(laparospic cholecystectomy,LC)在合并肝硬化患者中应用的围手术期特点。方法:回顾性分析2000年1月～2009年1月40例腹腔镜治疗合并肝硬化(Child肝功能A级或B级)的胆囊结石患者的临床资料。结果:36例LC手术成功,4例中转开腹。中转开腹原因为Calot三角区致密粘连、解剖困难2例,胆囊动脉出血镜下止血困难2例,LC平均手术时间为62min,术中平均出血80ml,平均住院9.6d。2例术后出现腹腔积液,经护肝、支持、利尿治疗,6、8d后腹腔积液消失,无胆道损伤,术后无大出血,无肝功能衰竭和死亡患者。结论:经过充分的术前准备,术中、术后恰当的处理,LC在合并轻、中度肝硬化患者中应用是安全有效的,但应严格掌握适应证。
Objective: To investigate the perioperative characteristics of laparospoccollectomy (LC) in patients with cirrhosis. Methods: The clinical data of 40 patients with cholecystolithiasis from cirrhosis (Child grade A or B) with laparoscopy from January 2000 to January 2009 were retrospectively analyzed. Results: 36 cases of LC surgery was successful, 4 cases of laparotomy. The reasons of transit laparotomy were dense adhesion in Calot triangle area, 2 cases of anatomical difficulties, 2 cases of hemostatic difficulties under choledochoacin haemorrhage, LC average operation time of 62 minutes, mean intraoperative bleeding of 80ml and average hospitalization of 9.6 days. 2 patients had peritoneal effusion after treatment with liver, supportive and diuretic treatment. The ascites disappeared 6 and 8 days later, no bile duct injury, no postoperative hemorrhage, no liver failure and death. Conclusion: After adequate preoperative preparation, intraoperative and postoperative appropriate treatment, LC is safe and effective in patients with mild to moderate cirrhosis, but should be strictly controlled indications.