不同CO2气腹压对腹腔镜胆总管探查术后肝肠功能的影响

Effects of CO2 pneumoperitoneum pressure on liver function and intestinal function of patients undergoing laparoscopic common bile duct exploration

目的观察比较不同CO2气腹压力对腹腔镜胆总管探查术后患者肝功能与肠功能的影响。方法前瞻性分析2018年1月至2019年6月安徽医科大学附属安庆医院普外科符合标准的45例腹腔镜胆总管探查术患者,采用随机对照的方法分为两组,A组23例(气腹压力为8~12 mmHg),B组22例(气腹压力为13~15 mmHg),比较两组患者术后肝功能、血清前白蛋白(PA)及肠功能恢复情况。结果与B组比,A组术后第1天血清ALT[(55.51±19.43)U/L vs(69.90±19.82)U/L,P=0.018]、AST[(58.26±16.09)U/L vs(71.64±19.43)U/L,P=0.009]、血清TBIL[(23.44±7.88)μmol/L vs(32.48±13.96)μmol/L,P=0.010],均明显降低(P<0.05)。两组术后第4天血清ALT、AST、TBIL均基本恢复至正常水平。两组PA水平均在术后第1天有所下降,组间差异无统计学意义(P>0.05)。术后第4天PA值,A组明显高于B组[(34.90±5.67)mg/dL vs(28.08±4.41)mg/dL,P<0.05],A组术后肠鸣音恢复时间[(11.22±3.42)h vs(18.50±5.87)h,P<0.001]、排气时间[(15.74±2.94)h vs(22.95±5.33)h,P<0.001]均短于B组(P<0.05)。两组手术时间[(68.52±15.57)min vs(60.45±16.85)min,P=0.10]差异无统计学意义(P>0.05)。结论8~12 mmHg气腹压力对腹腔镜胆总管探查术患者肝功能、前白蛋白的影响相对较小,适当的低气腹压更利于腹腔镜胆总管探查术患者的早期恢复。

Objective To observe and compare the effects of different CO2 pneumoperitoneum pressure on liver and intestinal function of patients undergone laparoscopic common bile duct exploration(LCBDE).Methods The clinical data of 45 patients who undergone LCBDE in Anqing Hospital Affiliated to Anhui Medical University from Jan.2018 to Jun.2019 were analyzed prospectively.Patients were randomly divided into two groups:group A(23 cases,pneumoperitoneum pressure from 8 to 12 mmHg)and group B(22 cases,pneumoperitoneum pressure from 13 to 15 mmHg).The changes of liver function,serum prealbumin(PA)and intestinal function recovery were compared between the two groups.Results At the first day after LCBDE,compared with group B,levels of serum ALT[(55.51±19.43)U/L vs(69.90±19.82)U/L,P=0.018],AST[(58.26±16.09)U/L vs(71.64±19.43)U/L,P=0.009]and TBIL[(23.44±7.88)μmol/L vs(32.48±13.96)μmol/L,P=0.010]in group A were all lower.The levels of serum ALT,AST and TBIL recovered to normal levels on the fourth day after LCBDE in both groups.The serum levels of PA decreased on the first day after LCBDE in both groups,and the difference between the two groups had no statistical significance(P>0.05).On the fourth day after LCBDE,serum PA level in group A was higher than that in group B[(34.90±5.67)mg/dL vs(28.08±4.41)mg/dL,P<0.05].Postoperative bowel sound recovery time[(11.22±3.42)h vs(18.50±5.87)h,P<0.001],and anal exhaust time[(15.74±2.94)h vs(22.95±5.33)h,P<0.001]in group A were both shorter than those in group B.There was no significant difference in operation time between the two groups[(68.52±15.57)min vs(60.45±16.85)min,P=0.10].Conclusion 8~12 mmHg CO2 pneumoperitoneum pressure has a relatively small effect on liver function and prealbumin in patients undergoing LCBDE.Appropriate low pneumoperitoneum pressure is more conducive for early recovery of patients.