腹腔镜胆囊切除术后血浆TBIL、ALT、AST升高原因探讨

Reasons of the elevation of human serum TBIL, ALT and AST after laparoscopic cholecystectomy

目的 探讨腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)后血浆TBIL、ALT、AST升高原因。方法 本课题对我院1999年9-10月收治的胆囊结石伴慢性胆囊炎95例患者,随机分为A、B、C三组.A组32例,B组32例,C组31例。A组病人LC术中CO2气腹压维持在10mmHg,采用Stryker-200型单极电刀切除胆囊,胆囊床普遍电凝处理;B组病人LC术中CO2气腹压同A组,采用弯剪刀切除胆囊,钛夹钳闭止血,置放腹腔引流管;C组病人LC术中CO:气腹压维持在15mmHg,切除胆囊方法同B组。术后1、3、5、7天抽取患者外周静脉血送实验室测定TBIL、ALT、AST。结果 A组患者术后1、3天TBIL、ALT、AST水平变化均显著升高,第5天开始下降,第7天基本恢复正常,B、C组患者术后1、3、5、7天血浆TBIL、ALT、AST指标均无明显升高。三组患者血浆TBIL,、ALT、AST等三项指标变化均数经t检验统计学处理显示:A组患者术后1、3天三项指标变化与B组患者1、3天三项指标变化相比,A组差异有显著性临床意义(P<0.01);与C组患者术后1、3天三项指标变化相比,A组仍有显著性临床意义(P<0.01);而B组与C组术后1、3、5、7天三项指标变化相比无差异(P>0.05)。结论 LC术中CO2气腹压维持在15mmHg时对肝功能无明显影响,电凝电切所致热损是术后TBIL、ALT、AST指标升高的主要原因。

Objective To investigate the reasons of the elevation of serum TBIL, AUT, AST after laparoscopic cholecystectomy. Methods 95 cases of patients with chronic cholecystopathy from September to October in 1999, were divided into three groups A(n = 32),B(n = 32) and C(n = 31) by random. In group A, the gallbladders were removed by monopolar electrome (Stryker- 200)under the aeroperitonum pressure of lOmmHg, while the cholecystic bed was generalized electrocoagulated; In group B, we used the curve scissors to dissect and remove the gallbladders under the same pressure. The titanium clip hemostasis were used and a drainage tube needed around the operation field; In group C, the same method with Group B were used under the different pressure of 15 mmHg. The peripheral vein blood samples were collected in the 1st ,3rd,5th ,7th day postoperatively for the detection of TBIL, ALT, AST. Results The value of TBIL, ALT, AST dramatically elevated in the 1st ,3rd day postoperatively, and began to decrease in the 5 day .turned to be normal in 7days. All index above in Group B and C had no obvious elevation in the 1st ,3rd ,5th ,7th day after LC. The data were statistically analyzed with t - test and showed that: TBIL, ALT, AST in group A had significance difference with those in Group B and C (P<0.01). Those data in group B and C had no significance difference(P> 0.05) .Conclusion The pressure of 15 mmHg of CO2 areoperitonum has less harm to the liver function. The thermalelectric effect was the main factor of elevation of TBIL, ALT, AST after LC.