不同气腹压对糖尿病患者腹腔镜胆囊切除术后肝功能的影响

目的探讨不同气腹压对糖尿病患者腹腔镜胆囊切除术（LC）后肝功能的影响及其可能机制。方法选择糖尿病行LC术患者40例,根据术中CO2气腹压水平将患者分为2组：低气腹压组（LP组,n=20）腹内压（IAP）维持在1.3 kPa水平;标准气腹压组（SP组,n=20）IAP维持在1.6 kPa水平。各组患者分别于术前,术后1、24、72 h抽取静脉血测定肝功能,并对结果进行对比研究。结果 LP组和SP组血清ALT、AST、Tbil、DBil水平均在术后1、24 h明显升高（P〈0.01）,其中SP组升高更明显（P〈0.01）。2组在术后72 h血清ALT、AST、Tbil、DBil基本恢复至正常水平。结论在糖尿病患者LC术中建立CO2气腹是可行的,但可能引起糖尿病患者术后一过性肝功能异常,且与CO2气腹压的高低有关。

Effects of Different Pneumoperitoneum Pressures on Liver Function in Diabetic Patients Undergoing Laparoscopic Cholecystectomy

Objective To investigate the effects of different pneumoperitoneum pressures on hepatic function in diabetic patients undergoing laparoscopic cholecystectomy（LC）.Methods Forty diabetic patients treated with LC were divided into two groups： low pressure pneumoperitoneum with a constant intra-abdominal pressure of 1.3 kPa（LP group,n=20） and standard pressure pneumoperitoneum with a constant intra-abdominal pressure of 1.6 kPa（SP group,n=20）.Venous blood was collected to determine the liver function before operation and at 1,24 and 72 hours after operation.Results The levels of aminotransferase（ALT）,aspartate aminotransferase（AST）,total bilirubin（Tbil）and direct bilirubin（DBil）significantly increased at 1 and 24 hours postoperatively,but restored to normal levels at 72 hours postoperatively in both groups（P0.01）.Moreover,the increase in these serum indexes in SP group was more obvious than that in LP group（P0.01）.Conclusion The LC with carbon dioxide pneumoperitoneum is feasible in diabetic patients,but may result in transient liver function abnormalities,which relate to the levels of carbon dioxide pneumoperitoneum.