不同气腹压对老年患者腹腔镜胆囊切除术后肝功能的影响

Changes of hepatic function in elderly patients undergone laparoscopic cholecystectomy in response to different pneumoperitoneum pressure

目的探讨不同气腹压对老年患者腹腔镜胆囊切除术(LC)后肝功能的影响及其可能机制。方法选择60岁以上老年患者行LC76例,根据术中CO2气腹压水平将患者分为3组,即低气腹压组(LP组,n=20)腹内压(IAP)维持在1.3kPa水平、标准气腹压组(SP组,n=33)IAP维持在1.6kPa水平和高气腹压组(HP组,n=23)IAP维持在2.0kPa水平。其中SP组根据术中气腹维持时间再细分为两个亚组,即A亚组(时间>50min),B亚组(时间≤50min)。各组患者分别于术前、术后1d及术后4d抽取静脉血测定血清ALT、AST含量并进行对比研究。结果SP组和HP组的血清ALT、AST水平均在术后1d明显升高(P<0.01),其中HP组升高较SP组明显(P<0.01),而LP组升高不明显(P>0.05)。SP组在术后4d血清ALT、AST基本恢复至正常水平,而HP组虽有下降,但多数患者仍高于正常水平。SP组中的A亚组术后1d血清ALT、AST升高水平明显高于B亚组(P<0.01)。结论腹腔镜胆囊切除术中建立的CO2气腹可能引起老年患者术后一过性肝功能异常,且与CO2气腹压的高低和维持时间有关。

Objective To discuss the effect of different pneumoperitoneum pressure on changes of hepatic function in elderly patients treated with laparoscopic cholecystectomy （LC） and the corresponding mechanism. Methods A total of 76 patients at age over 60 years treated with LC were divided into three groups, ie, low pneumoperitoneum pressure group （Group LP, n = 20）, standard pneumoperitoneum pressure group （Group SP, n =33） and high pneumoperitoneum pressure group （Group HP, n=23） based on intraoperative CO2 pneumoperitoneum pressure. During operation, the intra- abdominal pressure （IAP） remained at 1.3 kPa in Group LP, 1.6 kPa in Group SP and 2.0 kPa in Group HP. In the meantime, according to maintenance of intraoperative pneumoperitoneum, Group SP was subdivided into two groups including Group A （〉50 min） and Group B （≤50 min）. Then, the venous blood was collected at day 1 preoperatively and at days 1 and 4 postoperatively respectively to determine and compare the contents of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in all groups. Results At day 1 postoperatively, the contents of ALT and AST in Groups SP and HP were significantly increased （ P 〈0.01）, with more significant increase in Group SP （P〈0.01） but insignificant increase in Group LP （ P 〈0.05）. At day 4 postoperatively, blood serum ALT and AST in Group SP decreased nearly to normal level but that in Group HP still remained at higher level than normal in most cases in spit of certain decrease. At day 1 postoperatively, the serum ALT and AST in Group A was increased more significantly than that in Group B. Conclusions CO2 pneumoperitoneum during LC may result in temporary abnormity of hepatic function in elderly patients, as correlates with level and maintenance time of CO2 pneumoperitoneum pressure.