腹腔镜胆囊切除术不同气腹压力对转氨酶的影响

Effect of pneumoperitoneum pressure upon hepatic enzyme in the patients undergone laparoscopic cholecystectomy

目的 探讨在低气腹压下行腹腔镜胆囊切除术的可行性及低气腹压力对转氨酶的影响.方法 对首都医科大学大兴区人民医院普外二科2010年1月-2015年4月门诊收治的胆囊结石和慢性非结石性胆囊炎患者共128例行腹腔镜胆囊切除术,按患者住院号尾号单双数分组,尾号为单号者分入常规气压组（A组：12～14mmHg）,尾号为双号者分入低气压组（B组：8～10 mmHg）,每组64例患者.应用SPSS12.0软件,采用t检验方法分析比较两组患者手术时间及术前1天、术后第1天、2天血清ALT、AST浓度差异.结果 两组患者均顺利完成手术.A组平均手术时间（65±6.5） min,B组平均手术时间（61±8.2）min,差异无统计学意义（t=2.212,P=0.976）.与A组相比,B组对转氨酶影响较小,两组数据差异有统计学意义（P＜0.05）.结论 采用低气腹压（8 ～ 10mmHg）下行腹腔镜胆囊切除术是完全可行的,并不延长手术时间,同时有利于减少气腹压对转氨酶的影响,这对于术前转氨酶异常者尤为重要.

Objective To study the feasibility of laparoscopic cholecystectomy in low pneumoperitoneum pres sure and the effct of low pressure pneumoperitoneum on liver enzymes.Methods A total of 128 cases of laparoscopic gallbladder resection for gallbladder stones or chronic acalculous cholecystitis patients came from outpatient of Department of Two General Surgery of Daxing Hospital Affiliated to Capital Medical University from Jan.2010 to Apr.2015.Patients with odd hospital numbers were divided into the conventional pressure group （group A：12-14 mmHg,n =64）.Patients with even numbers were divided into the low pressure group （group B：8-10 mmHg,n =64）.The venous blood was respectively collected at the first day and second day preoperatively to determine and compare the contents of alanine aminotransferase （ALT） and aspartate aminotransferase（AST） in two groups.The mean and standard deviation of the above indexes and operation time of two group patients are compared.Results All patients were successfully completed surgery.The average operation time of group A was （65 ± 6.5） minutes,and group B was （61 ± 8.2） minutes,and there was no significant difference between the two groups （t =2.212,P =0.976）.Compared with the A group,the B group had less effect on the aminotransferase,the data of the two groups were significantly different （P 〈 0.05）.Conclusion Laparoscopic gallbladder resection underwent the low pneumoperitoneal pressure （8-10 mmHg） is safe and feasible,doesnt extend the operation time,and helps to reduce the effect of pneumoperitoneum pressure on transaminase,which is much important for patients with abnormal aminotransferase preoperative.