不同CO_2气腹压力对糖尿病患者LC术后肝功能的影响

The different CO_2 pneumoperitoneum pressure influence on hepatic function in diabetic patients after laparoscopic cholecystectomy

目的探讨腹腔镜手术不同CO_2气腹压对于糖尿病患者肝功能的影响。方法选择单纯胆囊结石合并糖尿病行腹腔镜胆囊切除术患者60例,根据术中气腹压水平随机分为Ⅰ,Ⅱ,Ⅲ3组,每组20例,Ⅰ组:气腹压力为7mm Hg;Ⅱ组:气腹压力为12mm Hg;Ⅲ组:气腹压力为15mm Hg。术后1h、24h、48h、72h分别采静脉血5ml,测定血清中ALT、AST、GGT、TBIL的浓度。结果Ⅰ,Ⅱ,Ⅲ组术后1,24,48h的ALT、AST、GGT、TBIL都较术前显著升高(P<0.01),术后72h仅Ⅲ组较术前升高(P<0.01),Ⅰ,Ⅱ组也升高,但和术前比差异无显著性(P>0.05)。与Ⅰ,Ⅱ组相比Ⅲ组术后各时间点血清中ALT、AST、GGT、TBIL的浓度都显著升高(P<0.01);与Ⅰ组相比,Ⅱ组术后1,24,48h血清中ALT、AST、GGT、TBIL的浓度都显著升高(P<0.01)。结论 CO_2气腹能够引起糖尿病患者明显肝功能损害,气腹压力越大,肝功能损害程度越重。短时间低CO_2气腹压和常规CO_2气腹压引起糖尿病患者肝功能损害是一过性的。

Objective To investigate the influence of different CO2 pneumoperitoneum pressure on hepatic function in diabetic Patients received laparoseopic surgery. Methods According to the intra-abdominal pressures of CO2 pneumoperitoneum,60 cases of simple gallbladder stones with diabetes mellitus treated with LC were randomly divided into 3 groups ：7mmHg group （group Ⅰ ;n=20）, 12mmHg group（group Ⅱ n=20）, 15mmHg group（groupm ,n=20）. Venous blood was tollected to determine the concentrations of ALT,AST,GGT, TBIL in serum at 1,24,48 and 72 hours postoperativel. Results The levels of ALT,AST,GGT and TBILin group Ⅰ , Ⅱand Ⅲat 1,24 and 48 hours postoperativel were significantly higher than those preoperation,Those in group m at 72 hours were also significantly higher than that before operation. Those in group Ⅰ and Ⅱwere also elevated,but there was no significant difference（P〉0.05）. The levels of ALT,AST,GGT,and TBil in group Ⅲ were significantly higher than those in group Ⅰ and Ⅱat all times after operation （P〈0.01）. Compared with the Ⅰ group,the levels of ALT,AST,GGT,TBil in group Ⅱ were significantly increased at 1,24 and 48 hours postoperativel （P〈0.01）. Conclusion CO2 pneumoperitoneum could cause significant liver damage in diabetic patients, and the higher the pneumoperitoneum pressure was,liver function damage was more significantly. The liver damage in diabetic patients was temporary after short time of the low CO2 pneumoperitoneum pressure or conventional CO2 pneumoperitoneum pressure, and the higher the pneumoperitoneum pressure was,liver function damage was more obvious. The liver damage in diabetic patients was temporary after short time of the low CO2 pneumoperitoneum pressure or conventional CO2 pneumopentoneum pressure.