肝硬化门脉高压症脾切除一期行胆囊切除术17例治疗的经验.docVIP

肝硬化门脉高压症脾切除一期行胆囊切除术17例治疗的经验 　　【摘要】 目的总结肝硬化门静脉高压症合并胆囊结石的临床治疗经验。方法 回顾性分析17例肝硬化门脉高压症合并胆囊结石并行手术治疗患者的临床资料。结果 本组在行脾切除、贲门周围血管离断术的同时行胆囊切除6例，其中3例术后出现大出血，2例死亡；行胆囊大部切除10例，行胆囊取石加造瘘1例，均无并发症发生，痊愈出院。结论 肝硬化门脉高压症脾切除一期行胆囊切除术具有可行性，主要危险在于术中难以控制的大出血和术后肝功能衰竭，胆囊大部切除术既可缓解症状，又可有效减少手术风险，可作为此类患者的首选。? 　　【关键词】 肝硬化门脉高压症；胆囊结石；胆囊切除术? 　　?? 　　Homochronous operation of lien and gallbladder for cirrhotic potal hypertension concurrent cholecystolithiasis: areport of 17 cases. 　　DONG He-ping,WEI Li-ping.Department of General Sugery, the Affiliated Xin tai Hospital of Taishan Medical College, Shandong 271200,China? 　　【Abstract】 Objective To evaluate the experience of treatment for cirrhotic potal hypertension concurrent cholecystolithiasis. Methods The clinical data of 17 patients with cirrhotic potal hypertension concurrent cholecystolithiasis undergoing splenectomy and cholecystectomy were retrospectively analyzed． Result Six patients underwented splenectomy, peri-cardiac devascularization and cholecystectomy simultaneously. Two patients died and three patients were hemorrhage, ten patients underwented partial cholecystectomy and one patientsunderwented cholecystostomy, all patients had no complications. Conclusion Cholecystectomy and splenectomy can be carried out in selected patients with liver cirrhosis and portal hypertension. Uncontrollable hemorrhage and liver function failure are main risk. Partial cholecystectomy can relieve symptoms and reduce the risk of operation , therefore, as a preferred operation. ? 　　【Key words】 Cirrhotic portal hypertension; Cholecystolithiasis；Cholecystectomy 　　? 　　肝硬化并发胆石症的概率较普通人群高出2．0～5．5倍[1,2]。肝硬化-胆囊切除术被公认为是一对高危因素的结合[3]。 肝硬化伴发胆囊结石时，一期采用脾切除术和胆囊切除术文献报道有争议。本院自1996年8月至2006年8月手术治疗肝硬化门静脉高压合并胆石症患者17例，就治疗经验报告如下。? 　　1 临床资料? 　　1．1 一般资料 本组男11例，女6例，年龄34～68岁，平均48岁。均结合病史、体检、化验、影像学检查确诊为肝硬化合并胆囊结石。肝功能Child分级A级10例，B级7例。胃镜、上消化道钡餐透视提示：中重度食管静脉曲张9例，合并单纯胆囊结石15例，胆囊结石并慢性胆囊炎2例。全组均为乙肝后肝硬化。? 　　1．2 手术方式 全组均手术治疗，在行脾切除、贲门周围血管离断术的同时行胆囊切除术6例，行胆囊大部切除术10例，行胆囊切开取石胆囊造瘘术1例。? 　　2 结果? 　　17