关键词: 急性胆囊炎, 肝硬化, 腹腔镜下胆囊切除术, 胆囊炎分级, 终末期肝病模型, 治疗

Abstract: Objective The aim of this study was to investigate the evaluation of surgical risk in patients with liver cirrhosis and acute cholecystitis (AC) by cholecystitis severity grading and model for end-stage liver disease (MELD) scores. Methods 92 patients with LC and AC were enrolled in our hospital between February 2021 and December 2022, and all patients underwent laparoscopic cholecystectomy (LC). Before operation, the AC severity was evaluated according to Tokyo Guidelines (2018), including grade I in 55 cases and grade II/III in 37 cases, and the MELD scores were calculated, including low risk (≤14) in 64 cases and moderately/high risk (＞15) in 28 cases. The surgical risk was evaluated by multivariate Logistic regression analysis. Results The rates of conversion to laparotomy during LC were not significantly different among groups(P＞0.05); the operation time in patients with cholecystitis grade Ⅱ/Ⅲ was (88.8±11.8)min, much longer than [(77.1±10.4)min, P＜0.05], and intra-operational blood loss and peritoneal drainage were (91.4±18.7)mL and (339.7±40.7)mL, both significantly greater than [(79.5±12.2)mL and (285.9±36.4)mL, respectively, P＜0.05] in patients with grade Ⅰ, while there were no significant differences as respect to these surgical parameters between patients grouped on MELD scores(P>0.05); the incidence of post-operational complications, such as infection, bleeding and bile leakage in patients with grade Ⅱ/Ⅲ was 27.0%, much higher than 7.3%(P＜0.05) in patients with grade Ⅰ, and that was 28.6% in patients with high risk MELD scores, much higher than 9.4%(P＜0.05) in patients with low risk MELD scores; the patients were then further divided into with (n=18)and without (n=74) surgical risk groups based on surgical complications, and the percentages of cholecystitis grade Ⅱ/Ⅲ and the high MELD scores in patients with surgical risk were 61.1% and 55.6%, both significantly higher than 35.1% and 24.3%(P＜0.05) in those without surgical risk; the multivariate Logistic regression analysis showed that the cholecystitis grading and poor MELD scores were the independent risk factors for LC operation in cirrhotics with AC (P＜0.05). Conclusion The surgeons should take the cholecystitis severity grading and MELD scores into consideration before LC operation in patients with liver cirrhosis and AC, and deal with appropriately.

Key words: Acute cholecystitis, Liver cirrhosis, Laparoscopic cholecystectomy, Cholecystitis severity grading, Model for end-stage liver disease, Therapy