腹腔镜胆囊切除术后血清TBIL、ALT、AST水平变化的对比性临床研究

CLINICAL RESEARCH OF VARIATION OF SERUM TBIL, ALT AND AST AFTER LAPAROSCOP-IC CHOLECYSTECTOMY

目的:探讨腹腔镜胆囊切除术(LC)术后血清TBIL、ALT、AST升高原因。方法:1999—09～10我院收治的95例胆囊结石患者,随机分为A、B组各32例,C组31例。A组患者LC术中CO2气腹压设置在1.3kPa,单极电刀切除胆囊.胆囊床普遍电凝处理,B组患者LC术中CO2气腹压同A组,弯剪刀切除胆囊,钛夹钳闭止血、常规置放腹腔引流.C组患者LC术中CO2气腹压设置在2kPa,切除胆囊方法同B组。术后1、3、5、7d抽外周静脉血送实验室测定TBIL、ALT、AST含量。结果:术后1d血清TBIL、ALT、AST含量A组患者明显升高,B、C组患者无升高,三组相比(F检验),A组有显著性临床意义(P<0.01)。结论:LC术中电刀对肝外胆管热效应和对局部肝组织热损伤是术后血清TBIL、ALT、AST升高的主要原因,近期可恢复正常。远期对肝功能无影响。

Objective: To investigate the reasons for serum TBIL, ALT and AST elevation after laparoscopic chole-cystectomy (LC). Method: 95 patients with gallstone admitted form Sep. to Oct. 1999 were divided randomly into three groups, group A (n=32), group B (n = 32) and group C (n = 31). In group A, the gallbladder was resected by monopolar cautery under 1. 3kPa pneumoperitonum pressure and cystic bed was generally electrocoagulated. In group B. a pair of microscissors was used to resesct the gallbladder and the cystic artery was clipped with titanium clip under the same pneumoperitonum pressure as group A, and at the end of the LC, abdominal drainage tube was placed. In group C, the same operational procedure as group B, except the pneumoperitonum pressure (2 kPa). The levels of serum TBIL, ALT and AST of these patients were measured at the 1st, 3rd, 5th and 7th postoperative day. Result: The levels of TBIL, ALT and AST in group A were elevated significantly at the 1' postoperative day, but no elevation of these three indexes in other two groups. Compared with group B and C, the elevation in group A was significant (P<0. 01). Conclusion: Thermal injury formation electrocautery to the local liver tissures and thermal effects on the extrahepatic bile duct are the major reasons for the elevation of ALT and AST during early time after LC. The elevation of TBIL. ALT and AST can return to the normal levels and liver function is unimpaired in long term.