Objective To investigate the safety and feasibility of laparoscopic cholecystectomy (LC) in the treatment of portal hypertension conplicated by gallstones.Methods A retrospective analysis was performed for the clinical data of 96 patients with portal hypertension complicated by gallstones who underwent surgical treatment in The Fourth People's Hospital of Zigong from January 2012 to June 2016.These patients were divided into laparoscopic group with 50 patients who underwent LC and open group with 46 patients who underwent open cholecystectomy.The surgical conditions and changes in liver function after surgery were compared between the two groups.An analysis of variance with repeated measures was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for comparison between two groups;the t-test was used for comparison between two groups.The chi-square test was used for comparison of categorical data between groups.Results No deaths occurred during the perioperative period and no patient was converted to open surgery in the laparoscopic group.Compared with the open group,the laparoscopic group had significantly lower time of operation,intraoperative blood loss,length of hospital stay,hospital costs,and incidence rate of postoperative complications (t =2.075,7.389,4.839,and 3.809,x2 =4.697,all P ＜0.05).Both groups had increased or reduced serum levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil),and albumin (Alb) at 1 day after surgery,which gradually returned to preoperative levels at 3 or 7 day after surgery.The laparoscopic group had significant changes in the serum levels of ALT,AST,and Alb (F =201.85,185.55,and 4.570,all P ＜ 0.01),while the open group had significant changes in the serum levels of ALT,AST,TBil,and Alb (F =597.84,373.10,5.617,and 10.429,all P ＜ 0.01).There were significant increases in the serum levels of ALT and AST 1 day after snrgery in the laparoscopic group and at 1 and 3 days after surgery in the open group (all P ＜0.05),and at 1 and 3 days after surgery,the laparoscopic group had significantly lower serum levels of ALT and AST than the open group (t =12.537,18.370,9.548 and 15.118,both P ＜0.01).At 1 day after surgery,the open group had a significant increase in the serum level of TBil (P ＜ 0.05) and a higher serum level of TBil than the laparoscopic group (t =2.547,P =0.013).There were significant reductions in the serum level of Alb at 1 day after surgery in the laparoscopic group and at 1 and 3 days after surgery in the open groups (all P ＜ 0.05),and at 1 day after surgery,the laparoscopic group had a significantly higher serum level of Alb than the open group (t =2.291,P =0.024).Conclusion LC is safe and feasible in the treatment of portal hypertension complicated by gallstones,and compared with open cholecystectomy,it has the advantages of a minimally invasive surgery and causes less liver damage.%目的 探讨腹腔镜胆囊切除术(LC)治疗门静脉高压症合并胆囊结石的安全性和可行性.方法 回顾性分析自贡市第四人民医院2012年1月-2016年6月收治的96例行手术治疗的门静脉高压症合并症状性胆囊结石患者的临床资料,其中50例行LC(腹腔镜组),46例行开腹胆囊切除术(开腹组).比较2组患者手术相关情况及术后肝功能的变化.多组间比较采用重复测量资料的方差分析,进一步两两比较采用LSD-t检验;2组间比较采用t检验.计数资料组间比较采用x2检验.结果 2组患者均无围手术期死亡病例,腹腔镜组无中转开腹病例.腹腔镜组的手术时间、术中出血量、住院时间、住院费用和术后并发症发生率均低于开腹组(t值分别为2.075、7.389、4.839、3.809;x2 =4.697,P值均＜0.05).2组患者血清ALT、AST、TBil和Alb水平术后1d均升高或下降,术后3、7d逐渐恢复术前水平.除腹腔镜组的TBil之外,其余组内比较差异均有统计学意义(F值分别为201.85、597.84、185.55、373.10、5.617、4.570、10.429,P值均＜0.01).腹腔镜组术后1d和开腹组术后1、3d血清ALT、AST水平均显著高于同组术前水平(P值均＜0.05),且腹腔镜组术后1、3d血清ALT和AST水平均明显低于开腹组(t值分别为12.537、18.370、9.548、15.118,P值均＜0.01).开腹组术后1d血清TBil水平高于术前(P＜0.05)和腹腔镜组术后1d水平(t=2.547,P=0.013).腹腔镜术后1d和开腹组术后1、3d血清Alb水平均低于同组术前水平(P值均＜0.05),且腹腔镜组术后1d血清Alb水平明显高于开腹组(t=2.291,P=0.024).结论 LC治疗门静脉高压症合并胆囊结石是安全可行的,而且较开腹手术而言,有明显的微创优势,对肝功能的损伤较小.
展开▼
