不同海拔地区腹腔镜胆囊切除术对肝功能影响的探讨

Effects of different altitudes on the patients ' liver function undergoing laparoscopic cholecystectomy

目的:通过对比不同海拔地区行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者手术前后的肝功能指标,探讨海拔高度对LC患者肝功能的影响。方法:在不同海拔地区共选择80例慢性胆囊疾病患者行LC,根据手术地点的海拔不同,分成两组,A组为西宁地区患者(平均海拔2 200 m),B组为兴海县患者(平均海拔3 300 m),术中气腹压力维持在14 mm Hg,分别于术前1 d及术后第1天、第3天、第5天取空腹外周静脉血测定肝功能各项指标,包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)。结果:与术前1 d相比,两组患者术后第1天、第3天肝功能ALT、AST、TBIL、DBIL均显著升高,且以术后第3天最为显著(P<0.05);至术后第5天,A组患者ALT、AST、TBIL、DBIL已恢复术前水平,而B组患者仍维持在较高水平。A、B两组相比,B组患者术后ALT、AST、TBIL、DBIL均高于A组(P<0.05)。结论:在CO2气腹压力一定的情况下,海拔高度可能是LC术后引起患者肝功能变化的因素之一,海拔越高,对肝功能的影响越明显,持续时间越长,以术后第3天最为显著。

Objective：To explore the effects of different altitudes by observing the patients hepatic function following laparo- scopic cholecystectomy （LC）. Methods ： Based on the selection criteria, 80 patients with chronic gallbladder diseases underwent LC. According to the different altitude during the operation, these patients were divided into two groups：patients of group A in Xining area （ an average elevation of 2 200 m） ;patients of B group in Xinghai area （ an average elevation of 3 300 m）. The CO2 pneumoperitoneum pressure was kept on 14 mmHg during the operation. Then, the fasting peripheral venous blood was collected on the preoperative day 1 and the postoperative day 1, day 3 and day 5, in order to determine the change of liver function, including alannine aminotransferase （ ALT）, aspartate aminotransferase （ AST）, alkaline phosphatase （ ALP）, total bilirubin （ TBIL）, direct bilirubin （DBIL） and indirect bilirubin （IBIL）. Results：Compared with data on the preoperative day 1, ALT, AST, TBIL and DBIL on the postoperative day 1, day 3 of two groups were significantly increased, especially on the 3rd postoperative day （P 〈 0.05 ）. Until to the 5th postoperative day, the ALT, AST, TBIL and DBIL in group A returned to preoperative levels, but the group B remained at a higher level. In comparison with group A, the level of ALT,AST, TBIL and DBIL in group B were higher after surgery （P 〈 0.05 ）. Conclusious： If pneumoperitoneum pressure is constant, the altitude of the surgical site is one of the reasons for the change of liver function after LC. With the increase of altitude, the effect on liver function is more obvious, the duration is longer, especially on the 3rd postoperative day.