不同气腹压力下行腹腔镜胆囊切除术对老年患者术后肝功能的影响

Influence of laparoscopic cholecystectomy under different pneumoperitoneum pressure on postoperative liver function in elderly patients

目的 探讨不同气腹压下行腹腔镜胆囊切除术对老年患者肝功能的影响及作用机制。方法 回顾性分析2012年11月~2014年11月我院行腹腔镜胆囊切除术老年患者110例,根据术中CO2气腹压水平将患者分为低气腹压组（LP组）、标准气腹压组（SP组）和高气腹压组（HP组）。分别于术前,术后第1、4天抽取静脉血测定血清ALT、AST等含量并进行分析。结果 SP组和HP组患者的血清ALT、AST水平均在术后第1天明显升高（P〈0.01）,且HP组升高较SP组明显;HP组LDH、TBi L水平在术后第1天升高（P〈0.05）,且SP组术后血清ALT、AST恢复较HP组快。结论 腹腔镜胆囊切除术中CO_2气腹能引起老年患者术后一过性肝功能异常,尤其是对于高气腹压和气腹压维持时间较长的患者。

Objective To explore the influence of laparoscopic cholecystectomy under different pneumoperitoneum pressure on postoperative liver function in elderly patients as well as its possible mechanism. Methods One hundred and ten elderly patients undergone laparoscopic cholecystectomy in our hospital from November 2012 to November 2014 were retrospectively analyzed.According to different levels of pneumoperitoneum pressure in carbon dioxide,they were divided into low pneumoperitoneum pressure group （LP group）,standard pneumoperitoneum pressure group （SP group）,and high pneumoperitoneum pressure group （HP group）.The serum alanine aminotransferase （ALT） and aspartate aminotransferase（AST） were tested by drawing venous blood before surgery and one and four days after surgery.The two indicators were also monitored and analyzed. Results The level of ALT and AST was greatly increased one day after surgery in SP and HP group respectively （P〈0.01）.The increase in HP group was more obvious than that in SP group.In HP group,the level of lactate dehydrogenase （LDH） and total bilirubin （TBIL） was increased respectively in the first day after surgery （P〈0.05）.The level of ALT and AST returning to be normal after surgery in SP group was sooner than that of HP group respectively. Conclusion Pneumoperitoneum pressure of carbon dioxide in laparoscopic cholecystectomy can lead to transient abnormal liver functions after surgery in elderly patients,especially for patients with high pneumoperitoneum pressure or pneumoperitoneum pressure maintaining for a longer time.