Clinical effect of laparoscopic versus open cholecystectomy in treatment of patients with portal hypertension complicated by gallstones / 临床肝胆病杂志

ABSTRACT

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.