腹腔镜与开腹肝硬化脾切除肝功能和白细胞变化的比较

Comparison of Liver Function and White Blood Cell after Laparoscopic Versus Open Splenectomy for Cirrhosis.

目的观察肝硬化门脉高压症继发性脾功能亢患者行腹腔镜脾切除(laparoscopic splenectomy,LS)和开腹脾切除(open splenectomy,OS)术前后肝功能和血白细胞的变化。方法回顾性分析自2003年3月-2006年3月76例因肝硬化门脉高压症继发性脾功能亢进而行脾切除术患者的临床资料,其中LS 27例、OS 49例。收集和分析术前1天及术后第1、3、7天血谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(Tbil)、直接胆红素(Dbil)和血白细胞(WBC)。结果(1)两组术后第1天Tbil、Dbil比较差异有显著性(P<0.05),第1、3天WBC比较差异有显著性(P<0.05),第7天AST比较差异有显著性(P<0.05);两组术后ALT比较差异无显著性。(2)LS组ALT、AST、Tbil、Dbil术后均较术前升高,但仅AST升高有统计学意义(P<0.05);OS组ALT、AST、Tbil、Dbil术后均比术前显著升高,差异均有统计学意义(P<0.05)。结论肝硬化门脉高压症继发性脾功能亢进患者行LS和OS都会导致肝功能和血白细胞的变化,但OS变化更大,两者差异具有显著性,表明LS对肝功能影响和对机体的创伤比OS小。

Objective To investigate the changes of liver function and white blood cell of patients with liver cirrhosis, portal hypertension and secondary hypersplenism underwent laparoscopic splenectomy（LS） and open splenectomy（ OS）. Methods We analyzed 76 clinical data of patients with liver cirrhosis, portal hypertension and secondary hypersplenism, among those 27 underwent LS, 49 OS from Mar 2003 to Mar 2006 retrospectively. Blood samples were obtained and analyzed preoperatively and postoperatively on days 1, 3, and 7, including alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBil） , directed bilirubin （DBil） and white blood cell （WBC）. Results Between LS and OS, the serum levels of Tbil and Dbil had significant difference on the 1st postoperative day （ P 〈0.05 ） , the counts of WBC had significant difference on the 1st and the 3rd postoperative day （ P 〈0.05 ） , AST had significant difference on the 7th postoperative day （ P 〈 0.05 ） ; ALT had no significant difference postoperatively. The senlm levels of ALT, AST, Tbil and Dbil were elevated after operation in LS, but only AST had significant difference （ P 〈 0.05 ）. The serum levels of ALT, AST, Tbil and Dbil in OS were significantly elevated after operation （ P 〈 0.05 ）. Conclusions Both LS and OS can lead to the changes of liver function and white blood cell in patients with cirrhosis, but OS affects more, which illustrates that LS has less impaction on liver function and less injury to the body.