腹腔镜胆囊切除术后肝功能变化原因的探讨

Changes of hepatic function after laparoscope cholecystectomy.

目的 观察腹腔镜胆囊切除手术后肝功能变化规律,分析影响肝功能的原因.方法 60例胆囊良性病变且肝功能正常行胆囊切除术者,根据患者意愿以及适应证分为开腹胆囊切除术组20例,腹腔镜胆囊切除术A组（气腹压10 mmHg）20例,腹腔镜胆囊切除术B组（气腹压15 mmHg）20例.术前、术后第1、3、5天检测肝功能.结果 三组术后血清ALT、AST、TBIL均较术前升高,上述指标术后第3天明显下降,第5天正常.三组术后ALB均有下降,血清DBIL、GGT、ALP均无显著变化.结论 腹腔镜胆囊切除对肝功能有影响,和开腹胆囊切除一样,为一过性现象.全麻下,气腹压力在10～15 mmHg时,对肝功能的影响与传统开腹手术相比无显著性差异.

Objective To observe and analyze the changes of hepatic function after laparoscope cholecystectomy （LC） and the influencing factors. Methods Basted on the selection criteria, 60 patients with benign gallbladder diseases and normal hepatic function before LC were divided into 3 groups. Twenty patients in group A received LC with the intra-abdominal pressure of 10 mmHg, 20 patients in group B received LC with the intra-abdominal pressure of 15 mmHg, and the remaining 20 in group C received OC. The peripheral venous blood was sampled before LC, and on the postoperative day 1, 3, 5 to determine the serum levels of ALT, AST, TBIL, GGT, ALB and ALP. Resalts Serum ALT, AST and TBIL levels in 3 groups after LC were elevated as compared with those before LC, obviously declined on the 3^nl day after LC and returned to nomaal levels on the 5^th day. In 3 groups, ALB was reduced after LC. No significant changes was found in serum DBIL, GGT and ALP. Conclusion LC has no effects on the hepatic function. The effects are transient and LC has no significant impacts on recovery of the patients as OC Under the condition of intra-abdomiml pressure of 10-15 mmHg and general anesthesia, the effects of LC on hepatic function is the same to OC, suggesting that LC procedure is safe for the patients with normal or slightly abnormal hepatic function.