腹腔镜手术中气腹压力对患者术后肝脏功能的影响

EFFECTS OF PNEUMOPERITONEAL PRESSURE ON SHORT-TREM LIVER FUNCTION AFTER OPERATION IN PATIENTS UNDERGOING LAPAROSCOPIC OPERATION

目的观察腹腔镜手术中气腹压力不同对患者术后短期肝脏功能的影响以及探讨其可能的发生机理。方法选择40例腹腔镜胆囊切除术(LC),40例腹腔镜妇科手术各自分别被随机分成两组,每组20例,各分为低气压(8mmHg)和高气压(15mmHg)组。在术前及术后1、3、5天行肝功能检测,比较4组间术后肝功能的变化。结果LC组与妇科组中的高气压组与低气压组比较,谷草转氨酶(GOT)、谷丙转氨酶(GPT)、总胆红素升高明显。LC组中的高气压组与妇科组中的高气压组相比,以上几项检测值明显升高,二者之间有显著差异(P<0.05)。结论对于术前肝功能正常的病人,较高的气腹压力对人体肝脏功能产生较大的影响,LC尤甚于妇科手术。对肝功的影响于5天内基本消除。

Objective To observe the effect of different pneumoperitoneal pressure on short-term liver function after operation in patients undergoing laparoscopic operation and discuss the possible mechanism. Methods Forty patients scheduled for laparoscopic cholecystectomy were randomly divided into two groups of twenty patients each：low pressure group （8mmHg） and high pressure group （15mmHg）. Another forty patients scheduled for gynecologic laparoscopic surgery were divided into two groups the same. Liver function were tested and compared within these four groups before operation and 1,3,5 day after operation. Result Compared with low pressure group, glutamic-oxaloacetic transaminase （GOT） ,glutamicpyruvic transminase （GPT） and total bilirubin increased significantly in both high pressure group. GOT, GPT and total bilirubin in high pressure group of laparoscopic cholecystectomy increased further than high pressure group of gynecologic laparoscopic surgery（P〈0.05）. Conclusion Higher pneumoperitoneal pressure have more influence on human liver function,especially in laparoscopic cholecystectomy than in gynecologic laparoscopic surgery. These effects can be eliminated within 5 days.