腹腔镜胆囊切除术中高频电刀对肝脏损伤的影响

CLINICAL STUDY ON CHANGES OF HEPATIC PATHOLOGY AND SERUM ENZYMOLOGY AFTER LAPOROSCOPIC CHOLECYSTECTOMY WITH CAUTERY OR MICROSCISSORS

目的 研究腹腔镜胆囊切除术肝脏病理与酶学变化的原因。方法 1 999～ 2 0 0 1年我院收治的 6 9例胆囊结石随机分组。常规应用单极高频电刀行腹腔镜胆囊切除术 35例 (电切组 ) ,胆囊床普遍电凝处理 ;对照组应用剪刀行腹腔胆囊切除术 34例 (剪切组 ) ,钛夹钳闭止血 ;手术结束时每组抽样取 5例胆囊床底部边缘肝组织 1 cm× 1 cm一块 ,病理切片 ,光镜观察肝细胞的变化 ,全部受试者术后 1～ 5 d抽血测定血清 AL T、AST含量 ,数据均经统计学处理。结果 电切组术后 1 d血清AL T、AST水平显著升高 ,与术前相比 ,差异有显著性 (P<0 .0 1 ) ,与剪切组术后相比 ,差异有显著性 (P<0 .0 1 )。肝组织病理变化 ,电切组浅层 (电刀接触面 )肝细胞大部分热溶解坏死 ,其内层肝血窦扩散 ,肝细胞膜皱缩 ,深层 (1 cm )肝细胞变性水肿 ,剪切组肝细胞正常。结论 L C术中单极高频电刀在密闭腔内对局部肝组织的热损伤是引起肝细胞坏死、皱缩、水肿等不同程度的病理变化 ,深度可达 1 cm ,是术后血清 AL T。

Objective To investigate the reasons for the changes of hepatc pathology and serum enzymology after laparoscopic cholecystectomy(LC).Methods From 1999 to 2001,69 patients admitted for LC were randomly divided into two groups.In experimental group,the gallbladder was resected with monoplar cautery and cystic bed was generally coagulated in LC.In comparing group,the gallbladder was removed with microscissors and the cystic artery was clipped with titanium clip.For all patients in the two groups,hepatic tissue in bulk of 1×1cm and close to the cystic bed was sampled for histological study.The level of serum enzymology was measured on the first and 5th postoperative day.Results The level of ALT and AST in experimental group are higher significantly on the first postoperative day(P<0.01).Under microscope,coagulation necrosis of hepatocytes on the pland which cautery contact directly was observed.Expansion of the hepatic sinus,as well as shrinkage of hepatocytic membrane on the interior plane,and degeneration and edema of the hepatocytes on the base plane were noted.However,liver cells from the group B have no significant change.Conclusion thermal injury of the liver tissue is a major reason for changes of hepatic pathology and serum enzymology in the early time of postoperation.