RESUMEN
Objective To evaluate the preoperative liver function and prognosis of laparoscopic cholecystectomy (LC) in patients with cirrhosis,using the Child-Turcotte-Pugh classification and the model for end-stage liver disease(MELD) score.Methods From January 2009 to June 2013,973 patients who were admitted to the Department of General Surgery of our hospital and the HuiZhou Municipal Central Hosptial were studied.Of the 373 patients with cirrhosis,38 patients were excluded because of Child C,MELD ＞ 30,or laparotomy.The remaining 335 patients who received laparoscopic cholecystectomy were randomly divided into two groups The Child grade and MELD score were retrospectively analyzed.Results There was no significant difference in intraoperative hemorrhage between the Child A group [(106 ± 11) ml] and the Child B group [(109 ± 11) ml] (P ＞ 0.05).The R ＜ 14 scores in the MELD group [(58 ± 15) ml] was significantly lower than that in the R≥ 14 group [(120 ± 28) ml] (P ＜ 0.01).There was no significant difference in postoperative complications between the Child group A (10 cases,12％) and the Child group B (17 cases,21％) (P ＞0.05).There was a significantly lower incidence in the R ＜ 14 scores in the MELD group (10 cases,12％) than the R ≥ 14 group (27 cases,33％) (P ＜ 0.05).There was also no significant difference in the hospital stay between the Child A group (9 ± 1) and the Child B group (10 ± 2)(P ＞0.05) ; the R ＜ 14 score of the MELD group (7 ± 1) was significantly less than that of the R≥ 14 group (11 ±2) (P ＜0.01).There was no significant difference in the cost of hospitalization between the Child A group (1.337 ± 0.063) and the Child B group (1.359 ± 0.089) (P ＞ 0.05) ; the R ＜ 14 group (MELD score 1.108 ± 0.123) was significantly less than that of the R ≥ 14 group (1.568-± 0.117)(P ＜ 0.01).Conclusion Compared with the Child-Turcotte-Pugh classification,the MELD score was more scientific,objective and accurate in judging the preoperative liver function.It helped to predict the amount of intraoperative hemorrhage and postoperative morbidity,reduced hospital stay and hospitalization expenses.Therefore,the MELD scoring system more objectively guided the treatment of patients with cholecystitis with cirrhosis.
RESUMEN
Objective:To evaluate the effects of devascularization and shunt operation on portal hypertensive gastropathy.Methods:35 patients were divided into 3 groups:(1)devascularization group(14 patients);(2)shunt group(12 patients);(3)control group(9 patients).Gastroscopy was made preoperatively and postoperatively to observe the changes of gastric mucosa,the apoptotic indexes(AI) were measured by TUNEL and the expression of caspase-3 mRNA was detected by reverse transercription polymerese chain reaction(RT-PCR) method.Results:The AI and expression of caspase-3 mRNA of control group were (2.31?0.11)% and 0.51?0.03 respectively,the AI of other groups was significantly higher than the control group(P
RESUMEN
Objective:To evaluate the effects of disconnection and portacaval shunt on the expression of caspase-3 in rats with portal hypertensive gastropathy.Methods:42 wistar male rats were divided into 4 groups:(1)normal control group;(2)model control group;(3)disconnection group;(4)portacaval shunt group.The expression of caspase-3 mRNA was determined by reverse transcription polymerase chain reaction method.Results:The free portal pressure increased significantly from (1.15?0.13)kPa to (2.68?0.16)kPa after portal vein ligation(P05),while decreased significantly to (1.57?0.23)kPa through portacaval shunt(P