腹腔镜胆囊切除术后肝功能变化的临床分析

Clinical Analysis of Changes of Liver Function after Laparoscope Cholecystectomy

目的通过对腹腔镜胆囊切除术患者术后肝功能改变的多因素分析,探讨影响肝功能的原因。方法对275例急性结石性胆囊炎、慢性结石性胆囊炎、胆囊息肉等三组患者术前和术后1d、7d肝功能各指标,包括总胆红素﹑直接胆红素﹑谷丙转氨酶﹑谷草转氨酶﹑碱性磷酸酶及谷氨酰转肽酶等进行测定;以逐步回归分析法预测气腹压;手术时间及患者年龄等变量对术后肝功能变化的影响。结果急性结石性胆囊炎组和慢性结石性胆囊炎组术后1d血清ALT、AST均较术前显著升高(P<0.005或P<0.01),术后7d均恢复正常,胆囊息肉组术前、术后1d、7d肝功能各指标均无显著性改变;以逐步回归分析法得出AG、OT两个自变量入选方程,其回归方程为:Y=0.23OT+0.12AG-15.38。结论LC可致术后血清ALT、AST增高,其原因与结石性胆囊炎、AG和OT有关,但仅为一过性现象,不影响患者术后恢复,LC仍为一种可靠、安全的方法。

Objective To explore the reasons for the changes of liver function after laparoscope cholecystectomy（LC）. Methods 275 patients were divided into 3 groups： The cholecystolithiasis complying with acute cholecystitis group （group A,n=31）, The cholecystolithiasis complying with chronic cholecystitis group （group B,n=208） and the gallbladder polypus group （group C,n=36）. The levels of Serum TBIL,DBIL ALT,AST,AkP and T-GT were measured and compared before LC,and at days 1 and 7 postoperatively respectively in all groups; the correlated factors consisted of intra-abdominal pressure（IAP）,operation time（OT） and patients age（AG） of 275 patients with all groups were analyzed. Results The serum levels of ALT and AST were significantly higher at days 1 after LC than before LC in group A （P〈0.005 and P〈0.01） and B （P〈0.01） ,and retutned to normal levels at days 7 after LC,but in group C,no significant changes was found in all index of liver function before and after LC. Stepwise regress analysis of IAP,OT and AG as independent vafiables,ALT at days ld postoperatively as a strain variable. To select by P=0.05,OT and AG were gotten, the regress equation：Y=0.23OT＋0.12AG-15.38. Conclusion LC has negative effects on the liver function after LC,the major reasons are cholecystolithiasis complying with cholecystitis and AG and OT. The effects are transient and have no significant impacts on recovery of the patients after LC ,suggesting that LC procedure is safe.