Resumos
Considerando que são duas doenças freqüentes na população, a associação entre cirrose hepática e colelitíase também é um achado comum. É importante o conhecimento desta situação porque a evolução clínica da cirrose pode ser complicada pela presença de colelitíase e, ao contrário, uma colelitíase sintomática pode ser de difícil tratamento nos pacientes cirróticos. Os autores fazem uma revisão da literatura enfocando os aspectos clínicos e terapêuticos desta associação.
Colelitíase; Cirrose hepática
The cholelithiasis and hepatic cirrhosis are frequent in the population. This association is often observed. It’s important to known this situation because the evolution of cirrhosis may be complicated by cholelithiasis and, on the other hand, the treatment of symptomatic cholelithiasis may be difficult in cirrhotic patients. In the compensated disease (Child A and B), cholecystectomy is the treatment of choice. In patients Child C, the biliary surgery has a high morbi-mortality rate and the initial management must be clinical observation. In these cases, the biliary symptoms must be relieved and the surgery delayed, if possible, until the improvement of hepatic function. Jaundiced patients must be carefully evaluated in the preoperative period, specially because choledocholithiasis is frequently absent and the jaundice is caused by hepatic failure. In Child C patients, if surgery is really necessary, cholecystostomy or partial cholecystectomy by Pribram technique can be considerated. The authors reviewed the clinical and therapeutic aspects of this association.
Cholelithiasis; Hepatic cirrhosis
ARTIGO DE ATUALIZAÇÃO
Colelitíase e cirrose hepática
Cholelithiasis and hepatic cirrhosis
Paulo Roberto Ott Fontes, TCBC-RSI; Mauro NectouxII; Rene Jacobsen EilersIII
IProfessor Livre-Docente em Cirurgia, Coordenador do Curso de Pós-Graduação em Clínica Cirúrgica da FFFCMPA/ISCMPA
IICirurgião Geral da ISCMPA, Mestre em Cirurgia
IIICirurgião Geral, Membro do SGCC
Endereço para correspondência Endereço para correspondência: Dr. Paulo Roberto Ott Fontes Rua General Vitorino, 330/802 90020-170 - Porto Alegre - RS E-mail: prfontes@santacasa.tche.br
RESUMO
Considerando que são duas doenças freqüentes na população, a associação entre cirrose hepática e colelitíase também é um achado comum. É importante o conhecimento desta situação porque a evolução clínica da cirrose pode ser complicada pela presença de colelitíase e, ao contrário, uma colelitíase sintomática pode ser de difícil tratamento nos pacientes cirróticos. Os autores fazem uma revisão da literatura enfocando os aspectos clínicos e terapêuticos desta associação.
Unitermos: Colelitíase; Cirrose hepática.
ABSTRACT
The cholelithiasis and hepatic cirrhosis are frequent in the population. This association is often observed. Its important to known this situation because the evolution of cirrhosis may be complicated by cholelithiasis and, on the other hand, the treatment of symptomatic cholelithiasis may be difficult in cirrhotic patients. In the compensated disease (Child A and B), cholecystectomy is the treatment of choice. In patients Child C, the biliary surgery has a high morbi-mortality rate and the initial management must be clinical observation. In these cases, the biliary symptoms must be relieved and the surgery delayed, if possible, until the improvement of hepatic function. Jaundiced patients must be carefully evaluated in the preoperative period, specially because choledocholithiasis is frequently absent and the jaundice is caused by hepatic failure. In Child C patients, if surgery is really necessary, cholecystostomy or partial cholecystectomy by Pribram technique can be considerated. The authors reviewed the clinical and therapeutic aspects of this association.
Key words: Cholelithiasis; Hepatic cirrhosis.
Texto completo disponível apenas em PDF.
Full text available only in PDF format.
REFERÊNCIAS
1. Fomari F, Imberti D, Squillante MM, et al. Incidence of gallstones in a population of patients with cirrhosis. J Hospital 1994;20:747-801.
2. Fomari F, Civardi G, Buscarini E, et al. Cirrhosis of the liver: A risk factor for development of cholelithiases in males. Dig Dis Su 1990; 35: 1.403-08.
3. França LA, Santos ET, Carvalho AM, et al. Prevalência de litíase biliar em cirróticos: avaliação necroscópica. Arq Gastroenterol 1994;31 :92-5
4. Conte D, Barisani D, Mandelli C, et al. Cholelithiases in cirrhosis: analyses of 500 cases. Am J Gastroenterol 1991;86(11): 1629-32.
5. Castaing D, Houssin D, Lemoine J, et al. Surgical management of gallstones in cirrhotic patients. Ann J Surg 1983;146:310-3
6. Orozco H, Takahashi T, Mercado MA, et al. Long-terrn evolution of asymptomatic cholelithiasis diagnosed during abdominal operations for variceal bleeding in patients with cirrhosis. Am J Surg 1994; 168:232-4
7. Aranha GV, Sontag SJ, Greenlee HB. Cholecystectomy in cirrhotic patients: a formidable operation. Am J Surg 1982;143:55-60.
8. Doberneck RC, Sterling WA, Allison DC. Morbity and mortality after operation in nonbleeding cirrhotic patients. Am J Surg 1983; 146: 306-9.
9.Iannuzzi C, Cozzolnio G, Negro G. Elective cholecistectomy in selected cirrhotic patients. Acta Chir Belg 1993;93:147-50.
10. Kogut K, Aragoni T, Ackerman NB. Cholecystectomy in patients wint mild cirrhosis: A more favorable situation. Arch Surg 1985;120: 1.310-11.
11. Aranha GV, Kruss D, Greenlee HB. Theraupeutic options for biliary disease in advanced cirrhosis. Am J Surg 1988;155:374-7.
12. Dunnington G, Alfrey E, Samphnier R, et al. Natural history of cholelithiasis in patients with alcoholic cirrhosis. Ann Surg 1987; 205(3):226-9.
13. Wu CC, Hwang CJ, Lim TJ. Definitive surgical treatment for cholelithiasis in selective patients with liver cirrhosis. Int Surg 1993; 78:127-30.
14. Ishizaki Y, Bandai Y, Shimomura K, et al. Management of gallstones in cirrhotic patients. Surg Today 1993;23:36-9.
15. Bloch RS, Allaben RD, Walt AJ. Cholecystectomy in patients with cirrhosis: a surgical challenge. Arch Surg 1985;120:669-72.
16. Harnid S, Jafri W, Khan H, et al. Outcome of biliary tract surgery in unknown cirrhotics: a case control study. Am R Col Surg Engl 1993;75(6):434-36.
17. Ichiyanaqui C, Monge e, Huaman C, et al. Colelitiasis en pacientes con cirrosis hepatica. Rev Gastroenterol Peru 1996;16(1);43-7.
18. Diehl AK, Schwesinger WH, Holleman DR Jr., et al. Clinical correlates of gallstone composition: distinguishing pigment from cholesterol stones. Am J Gastroenterol 1995;90(6):967-72.
19. Child CG, Turcotte JG. "Modified Child-Pugh classification of the severity of liver disease". In: Grendell JH, McQuaid KR, Friedman SL (eds) - Current - Diagnosis & Treatment in Gastroenterology. 1st edition. Stamford,CO:Appleton & Lange 1996.
20. Schwartz SI. Biliary tract surgery and cirrhosis: a critical combination. Surgery 1981;90(4):577-83.
21. Vlahcevic ZR, Heuman DM. Cecil Textbook of Medicine. 20th edition. Philadelphia: WB Saunders Company 1996;p.815.
22. Dani R, Portella FW, Nogueira CED. Gastroenterologia Clínica. 3ª edição. Rio de Janeiro:Guanabara Koogan,1993.
23. Pribram BO. Mukoklase und drainagelose gallenchirurgie. Zentralbl Chir 1928;55:773-9.
24. Tocchi A, Liotta G, Lepre L, et al. Biliary calculi in liver cirrhosis. Clinical, epidemiologic & therapeutic aspects. Ann Ital Chir 1995; 66(6):865-9.
25. Soper NJ. Effect of nonbiliary problems on laparoscopic cholecystectomy. Am J Surg 1993;165:522-26.
26. Yerdel MA, Tsuge H, Mimura H, et al. Laparoscopic cholecystectomy in cirrhotic patients: expanding indications. Surg Lap End 1993; 03(3): 180-3.
27. D' Albuquerque LA, Miranda MP, Genzini T, et al. Laparoscopic cholecystectomy in cirrhotic patients. Surg Laparosc Endosc 1995; 5(4):272-6.
28. Lacy AM, Balaguer C, Andrade E, et al. Laparoscopic cholecystectomy in cirrhotic patients. Indication or contraindication? Surg Endosc 1995;9(4):407-8.
29. Chao SH, Lee PH. Transmural suture technique for trocar-site bleeding following laparoscopic cholecystectomy. Surg Endosc 1994;8(10): 1.230-1.
30. Talamini MA. Controversies in laparoscopic cholecystectomy: contraindications. Cholangiography, pregnancy and avoidance of complications. Baillieres Clin Gastroenterol 1993;7(4):881-96.
31. Moreira VF, Arribas R, Sanroman AL, et al. Choledocolithiasis in cirrhotic patients: is endoscopic sphincterotomy the safest choice? Am J Gastroenterol 1991;86(8):1.006-10. .
32. Prat F, Tennenbaum R, Ponsot P, et al. Endoscopic sphincterotomy in patients with liver cirrhosis. Gast Endosc 1996;43(2):127-31.
33. Sugiyama M, Atomi Y, Kuroda A, et al. Treatment of choledocholithiasis in patients with liver cirrhosis. Surgical treatment or endoscopic sphincterotomy? Ann Surg 1993;218(1):68-73
Recebido em 2/7/97
Aceito para publicação em 4/12/97
Trabalho do Serviço de Gastroenterologia Clínica e Cirúrgica (SGCC) do Complexo Hospitalar da Santa Casa de Porto Alegre e do Departamento de Cirurgia da Fundação Faculdade Federal de Ciências Médicas de Porto Alegre.
- 1. Fomari F, Imberti D, Squillante MM, et al. Incidence of gallstones in a population of patients with cirrhosis. J Hospital 1994;20:747-801.
-
2Fomari F, Civardi G, Buscarini E, et al. Cirrhosis of the liver: A risk factor for development of cholelithiases in males. Dig Dis Su 1990; 35: 1.403-08.
- 3. França LA, Santos ET, Carvalho AM, et al. Prevalęncia de litíase biliar em cirróticos: avaliaçăo necroscópica. Arq Gastroenterol 1994;31 :92-5
- 4. Conte D, Barisani D, Mandelli C, et al. Cholelithiases in cirrhosis: analyses of 500 cases. Am J Gastroenterol 1991;86(11): 1629-32.
- 5. Castaing D, Houssin D, Lemoine J, et al. Surgical management of gallstones in cirrhotic patients. Ann J Surg 1983;146:310-3
- 6. Orozco H, Takahashi T, Mercado MA, et al. Long-terrn evolution of asymptomatic cholelithiasis diagnosed during abdominal operations for variceal bleeding in patients with cirrhosis. Am J Surg 1994; 168:232-4
- 7. Aranha GV, Sontag SJ, Greenlee HB. Cholecystectomy in cirrhotic patients: a formidable operation. Am J Surg 1982;143:55-60.
- 8. Doberneck RC, Sterling WA, Allison DC. Morbity and mortality after operation in nonbleeding cirrhotic patients. Am J Surg 1983; 146: 306-9.
- 9.Iannuzzi C, Cozzolnio G, Negro G. Elective cholecistectomy in selected cirrhotic patients. Acta Chir Belg 1993;93:147-50.
-
10Kogut K, Aragoni T, Ackerman NB. Cholecystectomy in patients wint mild cirrhosis: A more favorable situation. Arch Surg 1985;120: 1.310-11.
- 11. Aranha GV, Kruss D, Greenlee HB. Theraupeutic options for biliary disease in advanced cirrhosis. Am J Surg 1988;155:374-7.
- 12. Dunnington G, Alfrey E, Samphnier R, et al. Natural history of cholelithiasis in patients with alcoholic cirrhosis. Ann Surg 1987; 205(3):226-9.
- 13. Wu CC, Hwang CJ, Lim TJ. Definitive surgical treatment for cholelithiasis in selective patients with liver cirrhosis. Int Surg 1993; 78:127-30.
- 14. Ishizaki Y, Bandai Y, Shimomura K, et al. Management of gallstones in cirrhotic patients. Surg Today 1993;23:36-9.
- 15. Bloch RS, Allaben RD, Walt AJ. Cholecystectomy in patients with cirrhosis: a surgical challenge. Arch Surg 1985;120:669-72.
- 16. Harnid S, Jafri W, Khan H, et al. Outcome of biliary tract surgery in unknown cirrhotics: a case control study. Am R Col Surg Engl 1993;75(6):434-36.
- 17. Ichiyanaqui C, Monge e, Huaman C, et al. Colelitiasis en pacientes con cirrosis hepatica. Rev Gastroenterol Peru 1996;16(1);43-7.
- 18. Diehl AK, Schwesinger WH, Holleman DR Jr., et al. Clinical correlates of gallstone composition: distinguishing pigment from cholesterol stones. Am J Gastroenterol 1995;90(6):967-72.
-
19Child CG, Turcotte JG. "Modified Child-Pugh classification of the severity of liver disease". In: Grendell JH, McQuaid KR, Friedman SL (eds) - Current - Diagnosis & Treatment in Gastroenterology. 1st edition. Stamford,CO:Appleton & Lange 1996.
- 20. Schwartz SI. Biliary tract surgery and cirrhosis: a critical combination. Surgery 1981;90(4):577-83.
-
21Vlahcevic ZR, Heuman DM. Cecil Textbook of Medicine. 20th edition. Philadelphia: WB Saunders Company 1996;p.815.
-
22Dani R, Portella FW, Nogueira CED. Gastroenterologia Clínica. 3ª edição. Rio de Janeiro:Guanabara Koogan,1993.
- 23. Pribram BO. Mukoklase und drainagelose gallenchirurgie. Zentralbl Chir 1928;55:773-9.
- 24. Tocchi A, Liotta G, Lepre L, et al. Biliary calculi in liver cirrhosis. Clinical, epidemiologic & therapeutic aspects. Ann Ital Chir 1995; 66(6):865-9.
- 25. Soper NJ. Effect of nonbiliary problems on laparoscopic cholecystectomy. Am J Surg 1993;165:522-26.
- 26. Yerdel MA, Tsuge H, Mimura H, et al. Laparoscopic cholecystectomy in cirrhotic patients: expanding indications. Surg Lap End 1993; 03(3): 180-3.
- 27. D' Albuquerque LA, Miranda MP, Genzini T, et al. Laparoscopic cholecystectomy in cirrhotic patients. Surg Laparosc Endosc 1995; 5(4):272-6.
- 28. Lacy AM, Balaguer C, Andrade E, et al. Laparoscopic cholecystectomy in cirrhotic patients. Indication or contraindication? Surg Endosc 1995;9(4):407-8.
-
29Chao SH, Lee PH. Transmural suture technique for trocar-site bleeding following laparoscopic cholecystectomy. Surg Endosc 1994;8(10): 1.230-1.
- 30. Talamini MA. Controversies in laparoscopic cholecystectomy: contraindications. Cholangiography, pregnancy and avoidance of complications. Baillieres Clin Gastroenterol 1993;7(4):881-96.
-
31Moreira VF, Arribas R, Sanroman AL, et al. Choledocolithiasis in cirrhotic patients: is endoscopic sphincterotomy the safest choice? Am J Gastroenterol 1991;86(8):1.006-10.
- 32. Prat F, Tennenbaum R, Ponsot P, et al. Endoscopic sphincterotomy in patients with liver cirrhosis. Gast Endosc 1996;43(2):127-31.
-
33Sugiyama M, Atomi Y, Kuroda A, et al. Treatment of choledocholithiasis in patients with liver cirrhosis. Surgical treatment or endoscopic sphincterotomy? Ann Surg 1993;218(1):68-73
Endereço para correspondência:
Datas de Publicação
-
Publicação nesta coleção
05 Ago 2010 -
Data do Fascículo
Abr 1998
Histórico
-
Aceito
04 Dez 1997 -
Recebido
02 Jul 1997