腹腔镜手术术中气腹压对肝功能的影响

Effects of pneumoperitoneal pressure on liver function after operation in patients undergoing laparoscopic operation

目的研究腹腔镜手术中气腹压对术后短期肝功能的影响。方法分别设立高气腹压腹腔镜胆囊切除组(HPLC)、低气腹压腹腔镜胆囊切除组(LPLC)、妇科手术组、泌尿外科手术组,每组40人,除低气腹压腹腔镜胆囊切除组的腹内压为7mmHg外,其余各组的气压均为14mmHg。在术前及术后24、48和72h抽血行肝功能检测,比较4组间术后肝功能的变化。结果在HPLC组及妇科手术组,术后24、48和72h的ALT、AST与术前比较有显著增高(P<0.01),但在术后72h时,基本降至正常范围;LPLC组术后24h和48h的ALT、AST较术前亦有显著增高(P<0.01),但术后72h即与术前差异无显著性(P>0.05),且增高幅度较HPLC组及妇科组显著降低(P<0.05),而在泌尿科组,ALT、AST较术前均无显著变化,各组患者手术前后的ALP、GGT、总胆红素无显著变化(P>0.05)。结论腹腔镜手术气腹压对术后短期肝功能有一定的影响,使ALT、AST增加,且气腹压越高,损伤越大,但这种作用是暂时的。

[Objective] To investigate the effect of different pneumoperitoneal pressure on short-term liver function after operation in patients undergoing laparoscopic operation. [Methods] Four groups were assigned including high-pressure laparoscopic cholecystectomy （HPLC） group, low-pressure laparoscopic cholecystectomy （LPLC） group, gynecologic laparoscopic surgery group and urological laparoscopic surgery group. Forty patients scheduled for each group, the pneumoperitoneal pressure was 14 mmHg except for 7 mmHg for LPLC group. Liver function were tested and compared between these four groups before operation and 24, 48, 72 hours after operation. [Results] 24, 48, 72 hours after operation, ALT and AST in HPLC and gynecologic laparoscopic surgery groups were significantly higher than preoperation （P 〈 0.01）. Then they decreased to normal levels 72 hours after operation. ALT and AST in LPLC also increased 24, 48 hours after operation, but there was no significant difference in ALT and AST beforeoperation and 72 hours after operation （P 〉 0.05）. Furthermore, the increased extent of ALT and AST in LPLC group was significantly lower than those in the formers （P 〈 0.05）. In urological laparoscopic surgery group, ALT and AST had no significant difference before and after operation. ALP, GGT and total bilirubin after operation were not significantly different from those before operation in each group （P 〉 0.05）. [Conclusions] To some extent, pneumoperitoneal pressure in patients undergoing laparoscopic operation has some adverse effects on short-term liver function after operation, which results in the increase of ALT and AST. Higher pneumoperitoneal pressure has more influence on human liver function even temporary.