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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.
RESUMO
Objective To investigate the relationship between peri-menopausal women blood lipid level and the gallstone disease in order to provide theoretical basis for the prevention of gallbladder stone.Methods Seventy-two patients with gallbladder calculus from Department of Hepatobiliary Surgery Jinshan District Central Hospital of Shanghai and 52 healthy women coming for physical examination as the control group.Participants were divided into five age groups (20-29,30-39,40-49,50-59 and 60-69 years old) and two age stages (young period (30-40 years old) and peri-menopausal period (45-55 years old)),total cholesterol (TC),triglyceride (TG),high density lipoprotein (HDL-C),low-density lipoproteins (LDL-C) and Body Mass Index (BMI) were determined and compared between the stone group and the control group at different age stages.Results In comparison of the menopausal transition period,the stone group had significantly lower blood TC,HDL-C and LDL-C levels than the control group (TC:(4.58 ± 0.27) mmol/L vs.(5.15 ± 0.26) mmol/L,t=3.112,P ＜0.01 ;HDL-C:(1.17 ±0.11) mmol/L vs.(1.40 ±0.08) mmol/L,t =3.351,P ＜0.01 ;LDL-C:(2.71 ± 0.30) mmol/L vs.(3.15 ± 0.26) mmol/L,t =2.437,P ＜ 0.05).For the young period,there were no significant difference on blood lipid level and BMI was observed between the stone group and the control group (P ＞ 0.05).The fat HDL-C level in blood was significantly lower in the stone group in the menopausal transition period than in the young period ((1.17 ± 0.11) mmol/L vs.(1.33 ± 0.07) mmol/L,t =2.455,P ＜ 0.05).The control group had significantly higher peri-menopausal TC,TG,LDL-C levels in blood and BMI than those in the control group young period (P ＜ 0.05) ; And HDL-C level,no significant difference (TC:(5.15 ± 0.26)mmol/L vs.(4.47 ± 0.34) mmol/L,t =3.175,P ＜ 0.01 ; TG:(1.88 ± 0.39) mmol/L vs.(1.10 ± 0.24)mmol/L,t=3.066,P＜0.01;LDL-C:(3.15 ±0.26) mmol/L vs.(2.71 ±0.31) mmol/L,t =2.261,P＜0.05;BMI:(24.75±0.99) kg/m2vs.(21.73±1.11) kg/m2,t=4.217,P＜0.01).Conclnsion For perimenopausal (45-55 years old) females,decline of serum TC,HDL-C and LDL-C levels may be related to the formation of cholesterol stone.Lower HDL-C level is closely associated with formation of cholesterol stone,indicating that it may be one of the measures to prevent gallbladder stone by adjusting blood fat in perimenopausal women.