CAJ | 학술논문

目的探讨胆石症合并肝硬化门静脉高压症的处理方法.方法回顾性分析总结胆石症合并肝硬变的患者共108例,行手术治疗78例.根据患者情况手术方式有经腹胆囊全切除、胆囊大部分切除术、经腹腔镜胆囊切除术、胆囊切除+脾切除术、先行脾切除+贲门周围血管离断术后行胆道手术、肝左外叶切除+胆道手术以及肝门胆管整形胆管空肠Roux-en-Y吻合术.经内窥镜治疗10例,采取非手术治疗20例.结果本组108例患者治愈73例,治愈率67.6％,好转32例(29.7％),死亡3例(2.8％),死亡原因为大出血和肝功能衰竭.手术并发症为腹水、黄疸、出血及肝功能不全.结论对于胆石症合并肝硬化门静脉高压症的患者,术前应准确评估,采取合适的合理的手术方式,掌握术中处理技术,以及积极的围手术期处理.对于Child C级患者应列为手术禁忌.
목적 탐토담석증합병간경화문정맥고압증적처리방법.방법 회고성분석총결담석증합병간경변적환자공108례,행수술치료78례.근거환자정황수술방식유경복담낭전절제、담낭대부분절제술、경복강경담낭절제술、담낭절제+비절제술、선행비절제+분문주위혈관리단술후행담도수술、간좌외협절제+담도수술이급간문담관정형담관공장Roux-en-Y문합술.경내규경치료10례,채취비수술치료20례.결과 본조108례환자치유73례,치유솔67.6％,호전32례(29.7％),사망3례(2.8％),사망원인위대출혈화간공능쇠갈.수술병발증위복수、황달、출혈급간공능불전.결론 대우담석증합병간경화문정맥고압증적환자,술전응준학평고,채취합괄적합리적수술방식,장악술중처리기술,이급적겁적위수술기처리.대우Child C급환자응렬위수술금기.
Objective To discuss the therapy of cholelithiasis complicated with cirrhotic portal hypertension (CPH).Method In this study,clinical data were reviewed on 108 cases with cholelithiasis complicated with hepatic cirrhosis,including 78 cases who underwent surgery.Results Open cholecystectomy,subtotal cholecystectomy,laparoscopic cholecystectomy,open cholecystectomy plus spleectomy,splenectomy plus pericardial devascularization before biliary duct operation,leftlateral hepatectomy with biliary duct operation,and hepatic portal bile duct anaplasty with Roux-en-Y cholangiojejunostomy.10 patients received endoscopic treatment and 20 were treated conservatively.Results 73 patients were cured,with a cure rate of 67.6％; 32 patients were doing well (29.7％);3 patients died (2.8％) of massive hemorrhage and hepatic failure.The operative complications included ascites,jaundice,hemorrhage and hepatic insufficiency.Conclusions Before operation,the conditions of the patient should be accurately evaluated and a correct operative treatment option should be selected.Child C grade patients should be contraindicated for any surgery.