腹腔镜手术对肝功能变化的影响

Changes in serum liver enzymes after laparoscopic surgery

目的 了解腹腔镜手术对肝功能变化的影响以及探讨其可能的发生机制。方法 286例腹腔镜胆囊切除术(LC)患者被随机分为a,b 2组,在术前及手术后第1、2、7天接受肝功能检测。把40例开腹胆囊切除术(OC)患者的手术前、后肝功能与LC进行对照。另外,18例腹腔镜结、直肠癌手术(LCR)患者与23例开腹结、直肠癌(OCR)手术的患者也参与了研究。结果 LC与LCR患者的血清谷丙转氨酶(ALT)与谷草转氨酶(AST)与术前比较,都有显著性差异(P<0.05)。LC与OC、LCR与OCR相比,ALT术后24 h与48 h均有显著性差异(P<0.05)。同样,LC与OC、LCR与OCR相比,AST术后24 h与48 h也均有显著性差异(P<0.05)。同时也对其他的肝功能指标进行了检测与数据处理,未发现有意义的改变。结论 腹腔镜手术可导致血清肝转移酶有统计学意义的短暂性增高。CO2气腹是造成血清肝转移酶变化的主要原因。这种血清肝脏酶学的短暂性改变对大多数接受腹腔镜手术的患者不会造成不良影响,无临床意义。

Objective To investigate the effect of laparoscopic surgery on the change of hepatic function, in terms of serum liver enzymes and to explore its possible mechanism. Methods The blood samples from 286 patients before and after LC were evaluated for liver enzyme levels. The results were compared with those taken from 40 open cholecystectomy (OC) patients. In order to evaluated the possible effect of CO2 pneumoperitoneum on serum liver enzyme levels, same blood tests were also performed in two groups of color-ectal cancer patients undergoing either laparoscopic resectormy( LCR,n =68) or open resection( OCR,n = 23). Results Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in LC and LCR patients were significantly increased after operation. These changes occurred in every group that had demonstrated remarkable difference before and after the operation (P < 0. 05 ). The degree in the change of ALT between LC and OC cases were statistically significant (P < 0. 05 ). The difference between LCR and OCR patients also show statistical significance (P < 0. 05 ). Similar changes occurred in AST. Comparison between preoperative and postoperative value, AST had remarkably difference within every group ( P < 0.05 ). The difference in AST change between LC and OC cases were statistically significant (P <0. 05 ). The same difference between LCR and OCR patients were statistically significant too (P <0.05). Postoper-atively on day 7, both enzymes returned to normal values in LC, OC and OCR patients except LCR patients whose enzymes still kept in a higher level. Conclusions Transient elevation of hepatic transaminases can occur after LC and LCR. The one of main possible mechanisms might be CO2 pneumoperitoneum. In most of the LC and LCR patients, these transient elevation of serum liver enzymes does not have any clinical signifi-