中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2012年
4期
306-309
,共4页
白明东%王建%徐海%章密密%赵严冬
白明東%王建%徐海%章密密%趙嚴鼕
백명동%왕건%서해%장밀밀%조엄동
肝硬化%胆囊切除术,腹腔镜%肝功能试验
肝硬化%膽囊切除術,腹腔鏡%肝功能試驗
간경화%담낭절제술,복강경%간공능시험
Liver cirrhosis%Cholecystectomy,laparoscopic%Liver function tests
目的 评价腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)与开腹胆囊切除术( open cholecystectomy,OC)的治疗结果及终末期肝病模型(model for end-stage liver disease,MELD)评分和CTP(Child-Turcotte-Pugh)分级预测肝硬化患者术中出血和术后并发症的价值.方法 将128例症状性胆囊良性病变合并肝硬化CTP A级和B级患者随机分为LC组(n=64)和OC组(n=64),数据采用t检验、Mann-Whitney U检验及Pearsonx2检验.结果 两组手术时间差异无统计学意义(t=1.761,P=0.081).LC组失血量超过200 ml人数比例少于OC组(x2 =4.467,P=0.035).LC组术后下床活动时间、恢复进食时间、住院时间、VAS-疲乏强度以及VRS-美容满意度评分等均明显优于OC组(t=5.424,t =8.573,t=15.634,Mann-WhitneyU=473.0,Mann-Whitney=145.0；均P=0.000).LC组手术后3日内VAS-疼痛强度评分均明显低于OC组(Mann-Whitney=6.0,Mann-Whitney=22.5,Mann-Whitney=24.0,Mann-Whitney=46.0；均P=0.000).以CTP分级为基础,LC组总并发症发生率低于OC组[24％( 14/58),38％ (24/64)；x2=4.582,P=0.032].以MELD评分14分为标准,LC组总并发症发生率也低于OC组[21％ (12/58),34％( 22/64)；x2=4.238,P=0.040].无论LC组还是OC组,术前MELD评分＜14分与≥14分者术中失血量和术后并发症发生率两项指标差异均有统计学意义(t=6.604,x2=5.007;P =0.000,P=0.025和t=6.045,x2=12.5;P =0.000,P=0.000)；而CTP A级和B级之间术中失血量和并发症发生率差异无统计学意义(t=1.020,x2=0.110;P=0.312,P=0.741和t=1.897,x2=0.533;P =0.063,P=0.465). 结论 CTPA级和B级患者能够安全实施LC.LC组在术中失血量、疼痛和疲乏强度、恢复进食时间、术后下床时间及住院时间、并发症发病率等方面均优于OC组.LC是肝硬化患者术式的首选.MELD评分能准确预测术中失血和术后并发症发生率.
目的 評價腹腔鏡膽囊切除術(laparoscopic cholecystectomy,LC)與開腹膽囊切除術( open cholecystectomy,OC)的治療結果及終末期肝病模型(model for end-stage liver disease,MELD)評分和CTP(Child-Turcotte-Pugh)分級預測肝硬化患者術中齣血和術後併髮癥的價值.方法 將128例癥狀性膽囊良性病變閤併肝硬化CTP A級和B級患者隨機分為LC組(n=64)和OC組(n=64),數據採用t檢驗、Mann-Whitney U檢驗及Pearsonx2檢驗.結果 兩組手術時間差異無統計學意義(t=1.761,P=0.081).LC組失血量超過200 ml人數比例少于OC組(x2 =4.467,P=0.035).LC組術後下床活動時間、恢複進食時間、住院時間、VAS-疲乏彊度以及VRS-美容滿意度評分等均明顯優于OC組(t=5.424,t =8.573,t=15.634,Mann-WhitneyU=473.0,Mann-Whitney=145.0；均P=0.000).LC組手術後3日內VAS-疼痛彊度評分均明顯低于OC組(Mann-Whitney=6.0,Mann-Whitney=22.5,Mann-Whitney=24.0,Mann-Whitney=46.0；均P=0.000).以CTP分級為基礎,LC組總併髮癥髮生率低于OC組[24％( 14/58),38％ (24/64)；x2=4.582,P=0.032].以MELD評分14分為標準,LC組總併髮癥髮生率也低于OC組[21％ (12/58),34％( 22/64)；x2=4.238,P=0.040].無論LC組還是OC組,術前MELD評分＜14分與≥14分者術中失血量和術後併髮癥髮生率兩項指標差異均有統計學意義(t=6.604,x2=5.007;P =0.000,P=0.025和t=6.045,x2=12.5;P =0.000,P=0.000)；而CTP A級和B級之間術中失血量和併髮癥髮生率差異無統計學意義(t=1.020,x2=0.110;P=0.312,P=0.741和t=1.897,x2=0.533;P =0.063,P=0.465). 結論 CTPA級和B級患者能夠安全實施LC.LC組在術中失血量、疼痛和疲乏彊度、恢複進食時間、術後下床時間及住院時間、併髮癥髮病率等方麵均優于OC組.LC是肝硬化患者術式的首選.MELD評分能準確預測術中失血和術後併髮癥髮生率.
목적 평개복강경담낭절제술(laparoscopic cholecystectomy,LC)여개복담낭절제술( open cholecystectomy,OC)적치료결과급종말기간병모형(model for end-stage liver disease,MELD)평분화CTP(Child-Turcotte-Pugh)분급예측간경화환자술중출혈화술후병발증적개치.방법 장128례증상성담낭량성병변합병간경화CTP A급화B급환자수궤분위LC조(n=64)화OC조(n=64),수거채용t검험、Mann-Whitney U검험급Pearsonx2검험.결과 량조수술시간차이무통계학의의(t=1.761,P=0.081).LC조실혈량초과200 ml인수비례소우OC조(x2 =4.467,P=0.035).LC조술후하상활동시간、회복진식시간、주원시간、VAS-피핍강도이급VRS-미용만의도평분등균명현우우OC조(t=5.424,t =8.573,t=15.634,Mann-WhitneyU=473.0,Mann-Whitney=145.0；균P=0.000).LC조수술후3일내VAS-동통강도평분균명현저우OC조(Mann-Whitney=6.0,Mann-Whitney=22.5,Mann-Whitney=24.0,Mann-Whitney=46.0；균P=0.000).이CTP분급위기출,LC조총병발증발생솔저우OC조[24％( 14/58),38％ (24/64)；x2=4.582,P=0.032].이MELD평분14분위표준,LC조총병발증발생솔야저우OC조[21％ (12/58),34％( 22/64)；x2=4.238,P=0.040].무론LC조환시OC조,술전MELD평분＜14분여≥14분자술중실혈량화술후병발증발생솔량항지표차이균유통계학의의(t=6.604,x2=5.007;P =0.000,P=0.025화t=6.045,x2=12.5;P =0.000,P=0.000)；이CTP A급화B급지간술중실혈량화병발증발생솔차이무통계학의의(t=1.020,x2=0.110;P=0.312,P=0.741화t=1.897,x2=0.533;P =0.063,P=0.465). 결론 CTPA급화B급환자능구안전실시LC.LC조재술중실혈량、동통화피핍강도、회복진식시간、술후하상시간급주원시간、병발증발병솔등방면균우우OC조.LC시간경화환자술식적수선.MELD평분능준학예측술중실혈화술후병발증발생솔.
Objective To evaluate laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) in compensated cirrhotics and model for end-stage liver disease (MELD) score and Child-Turcotte-Pugh (CTP) classification in predicting perioperative morbidity. Methods Between January 1998 and June 2011,128 cirrhotic patients of symptomatic innocuous gallbladder disease at CPT class A or B liver function were prospectively and randomly divided into LC group (64 patients) and OC group (64 patients ). Data were analyzed by T test, Mann-Whitney U test and Pearson x2 test.Results There was no statistical differences in operation time between the two groups ( t =1.761,P =0.081 ).The intraoperative blood loss ＞ 200 ml occurred in 15 ( 26％ ) LC patients and 35 ( 55％ ) OC patients ( x2 =4.467,P =0.035 ).LC patients had earlier up and about,earlier oral intake,short hospital stay ( t =5.424,t =8.573,t =15.634; P =0.000,respectively) and lower complication rate [ CTP:24％ (14/58) vs 38％ (24/64),x2 =4.582,P =0.032; MELD scores 21％ (12/58) vs 34％ (22/64),x2 =4.238,P =0.040] compared with OC patients.LC patients' VAS- fatigue and VAS-pain scores on first 3 days were lower than OC according to the VAS (visual analogue scale) (Mann-Whitney U =473.0,MannWhitney =6.0,Mann-Whitney =22.5,Mann-Whitney =24.0,Mann-Whitney =46.0; P =0.000,respectively),and the VRS-cosmetic score was higher in LC group than in the OC group according to the VRS ( verbal rating scale) ( Mann-Whitney =145.0,P =0.000).MELD score ＞ 14 predicted higher blood loss and complication rate regardless of LC or OC,while CPT classification did not seem to predict intraoperative bleeding volume and morbidity. Conclusions LC can be performed safely in cirrhotic patients with CPT class A and B.LC has less,blood loss lower postoperative complication rate,and quicker postoperative recovery.MELD score system is more valuable than CPT classification system in predicting blood loss and postoperative complication rate in cirrhotics undergoing cholecystectomy.
