内镜微创保胆取石术对肝功能的影响

Effect of endoscopic minimally invasive cholecystolithotomy on hepatic function

目的:探讨内镜微创保胆取石术对患者肝功能的影响。方法:选择胆囊结石、急性阑尾炎且术前肝功能正常的患者作为研究对象,55例行内镜微创保胆取石术(保胆组),同期55例行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),55例行腹腔镜阑尾切除术(laparoscopic appendectomy,LA)。分别测定术前及术后第1天、第4天肝功能指标,包括ALT、AST、ALP、TBIL。结果:3组患者年龄、性别、手术时间、出血量、术前肝功能等差异无统计学意义。LA组患者术后血清肝酶均无明显变化;术后第1天,保胆组、LC组ALT、AST、TBIL升高,保胆组患者于术后第4天恢复正常,ALP无明显变化。结论:LA对肝功能无影响,内镜微创保胆取石术及LC均对肝功能有一定影响,但均为一过性现象。内镜微创保胆取石术对肝功能存在影响可能与术中牵拉、术后胆囊功能一过性丧失有关。

Objective：To investigate the effect of endoscopic minimally invasive cholecystolithotomy （EMIC） on liver function.Methods：Based on the selection criteria,165 patients with normal preoperative hepatic function were divided into 3 groups,55 patients received laparoscopic appendectomy （LA）,55 underwent EMIC （EMIC group）,the rest adopted laparoscopic cholecystectomy （LC）.The peripheral venous blood was sampled before the operation,and on the postoperative day 1 and 4 to determine the serum levels of ALT,AST,ALP and TBIL.Results：There were no significant differences in age,gender,time of operation,volume of bleeding and preoperative hepatic function among the three groups.Pre-operative and post-operative comparison showed that there were no significant differences in serum levels of ALT,AST and ALP in LA group;The serum levels of ALT,AST and TBIL were elevated after the operation in EMIC and LC groups.But these 3 parameters returned to normal on the postoperative day 4 in EMIC group.Pre-operative and post-operative comparison also showed that there were no remarkable differences in serum levels of ALP in the EMIC and LC groups.Conclusions：LA has no effect on liver function.EMIC and LC have negative effects on the hepatic function,but the effects are transient.The effects of EMIC may be related to stretch of the liver and the transient loss of gallbladder function.