气腹压力对腹腔镜胆囊切除术后肝功能的影响

Effect of pneumoperitoneal pressure on hepatic function after laparoscopic cholecystectomy

目的:观察不同的气腹压力对腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者肝脏生化指标的影响。方法:选择2014年1月至2014年6月拟行LC的患者90例,随机分为A、B、C三组,每组30例,术中分别采用9 mm Hg(A组)、12 mm Hg(B组)及15 mm Hg(C组)的气腹压力,对比3组患者术前及术后第1天、第3天、第7天肝脏生化指标的变化。结果:术后第1天,3组患者ALT、AST、TBIL、DBIL、ALP及GGT均较术前升高(P<0.05),TP及ALB较术前降低(P<0.05);A组患者术后第3天ALT、AST、TBIL、DBIL、ALP、GGT、TP及ALB恢复正常;B、C两组于术后第7天恢复正常。3组患者ALT、AST、TBIL、DBIL、ALP、GGT、TP及ALB变化差异有统计学意义,其中C组变化最明显。结论:LC术中建立的CO2气腹可能是引起患者肝功能一过性变化的原因,且随气腹压力的上升变化更加明显。

Objective： To investigate the effect of different pneumoperitoneal pressures on biochemical indicators of liver in laparoscopic cholecystectomy（ LC）. Methods： Ninety patients who underwent LC from Jan. 2014 to Jun. 2014 were selected and randomly divided into groups A,B and C. There were 30 cases in every group,and 9 mm Hg,12 mm Hg and 15 mm Hg pneumoperitoneal pressures were used in group A,group B and group C respectively,biochemical indicators of liver were compared among 3 groups before operation and in the first,third and seventh day after operation. Results： The level of ALT,AST,TBIL,DBIL,ALP and GGT was increased and TP and ALB was decreased in three groups in the first day after operation（ P〈0. 05）. The level of ALT,AST,TBIL,DBIL,ALP,GGT,TP and ALB in group A recovered to preoperative level in third day,and level of these indicators in group B and C recovered to normal in seventh day. The level of ALT,AST,TBIL,DBIL,ALP,GGT,TP and ALB was different among three groups,the change was more significant in group C. Conclusions： The pneumoperitoneum during LC may be the reason of the temporary changes of hepatic function after LC,and the changes become obvious as the increase of pneumoperitoneal pressure.