腹腔镜胆囊切除术后肝脏功能改变原因探讨

由于腹腔镜胆囊切除术 (ＬａｐａｒｏｓｃｏｐｉｃＣｈｏｌｅｃｙｓｔｅｃｔｏｍｙ ,ＬＣ)与开腹胆囊切除术使用器械及操作方法不同 ,由其引起的并发症及其对机体的影响逐渐受到重视。本课题拟对ＬＣ术后肝脏功能变化的原因进行探讨。资料与方法我院 1999年 7～ 9月收治肝功能正常的慢性胆囊炎并胆囊结石 (无黄疸及胰腺炎病史 ,Ｂ超检查肝内外胆管正常 ) 96例 ,男 2 4例 ,女 72例 ,年龄 2 8～ 6 7岁 ,平均 47岁。随机分为电刀组 (Ａ组 )、非电刀高腹压组 (Ｂ组 )、非电刀低腹压组 (Ｃ组 ) ,Ａ组 32例 ,Ｂ组 30例 ,Ｃ组 34例。Ａ组除胆囊管、…     

腹腔镜胆囊切除术后血浆TBIL、ALT、AST升高原因探讨

目的 探讨腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)后血浆TBIL、ALT、AST升高原因。方法 本课题对我院1999年9-10月收治的胆囊结石伴慢性胆囊炎95例患者,随机分为A、B、C三组.A组32例,B组32例,C组31例。A组病人LC术中CO2气腹压维持在10mmHg,采用Stryker-200型单极电刀切除胆囊,胆囊床普遍电凝处理;B组病人LC术中CO2气腹压同A组,采用弯剪刀切除胆囊,钛夹钳闭止血,置放腹腔引流管;C组病人LC术中CO:气腹压维持在15mmHg,切除胆囊方法同B组。术后1、3、5、7天抽取患者外周静脉血送实验室测定TBIL、ALT、AST。结果 A组患者术后1、3天TBIL、ALT、AST水平变化均显著升高,第5天开始下降,第7天基本恢复正常,B、C组患者术后1、3、5、7天血浆TBIL、ALT、AST指标均无明显升高。三组患者血浆TBIL,、ALT、AST等三项指标变化均数经t检验统计学处理显示:A组患者术后1、3天三项指标变化与B组患者1、3天三项指标变化相比,A组差异有显著性临床意义(P<0.01);与C组患者术后1、3天三项指标变化相比,A组仍有显著性临床意义(P<0.01);而B组与C组术后1、3、5、7天三项指标变化相比无差异(P>0.05)。结论 LC术中CO2气腹压维持在15mmHg时对肝功能无明显影响,电凝电切所致热损是术后TBIL、ALT、AST指标升高的主要原因。     

腹腔镜下剪刀锐性切除胆囊的临床应用研究

目的 搪塞腔镜下应用剪刀锐性分离切除胆囊的可行性和对肝功能的影响。方法 １９９９年６－８月我院收治的慢性胆囊良性疾患６９例,随机分为Ａ、Ｂ两组,Ａ组３５例,Ｂ组３４例。Ａ组病人应用弯剪刀锐性分离切除胆囊,无法用钛夹钳闭的胆床渗血点用少量电凝止血处理,Ｂ组病人应用单电刀切除胆囊,胆档普遍电凝处理,术后１、３、５、７天抽取外周静脉血送实验室检查ＴＢＩＬ、ＡＳＴ、ＡＬＰ、γＧＧＴ,两样本均数进行ｔ检验统     

腹腔镜胆囊切除术对肝脏功能的影响及研究现状

1987年法国医生Mouret首创的腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC),目前已成为外科治疗胆囊疾病的首选术式.在LC实践中,国内外学者已开始注意到LC对肝脏功能的影响,并进行了临床观察和实验研究.本文拟就此研究现状作一综述.     

腹腔镜胆囊切除术中高频电刀对肝脏损伤的影响

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、AST一过性升高的主要原因     

腹腔镜胆囊切除术后腹痛原因分析

我院行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),其中6例患者术后出现腹痛,现总结其原因及预防报道如下.     

腹腔镜胆囊切除术与循环呼吸功能变化

腹腔镜胆囊切除术循环功能变化是ＣＯ２气腹后即时ＣＩ降低。头高位对循环影响，ＭＡＰ，ＳＶＲ升高。呼吸功能变化的胞肺顺应性、ＦＲＣ降低，ＰａＯ２无明显变化，ＳｖＯ２下降，ＰａＣＯ２增高。可发生通气障碍，节段性肺不张。ＡＳＡⅢ－Ⅳ病人强调监测ＣＩ，ＳｖＯ２，吸气平台压，ＰａＣＯ２。     

腹腔镜胆囊切除术后综合征的原因分析

从１９９３年至１９９７年我们对经腹腔镜胆囊切除手术４２１例病人进行跟踪随访分析腹腔镜胆囊切除术后仍有症状反复发作的原因及发生率，发生率是１６％，这个百分率与传统剖腹胆囊切除基本相同，腹腔镜胆发除术前、术中遗漏与胆囊无关疾病的诊断引起症状数量较同，良性和恶性，这个能反映出术前详细检查的重要性，与剖腹术比较腹腔手术时检查腔内病变是困难的，而有胆囊切除后胆道运动紊乱引起综合征经药物治疗后可得到改善。     

腹腔镜胆囊切除术适应证的探讨

目的　探讨不加选择的情况下腹腔镜胆囊切除术的适应证及临床疗效。　方法　总结 1998年～ 2 0 0 1年 8月未加选择连续实施的 2 4 3例腹腔镜胆囊切除术 ,分析其中转开腹率和手术疗效。　结果　全组 2 4 3例LC病人中共有 3例分别因胆囊床出血、胆管损伤、十二指肠与胆囊致密粘连胆囊三角解剖不清而中转开腹手术 ,中转开腹率为 1.2 %。术中并发症发生率为 1.2 % (3 2 4 3) ,术后并发症发生率为 0 .8% (2 2 4 3) ,总的手术并发症发生率为 2 .1% (5 2 4 3)。　结论　腹腔镜胆囊切除术对于规范化培训过的腹腔镜医师而言即使是急性期和萎缩性胆囊炎病人 ,也可在不明显增加手术并发症和中转开腹率的情况下安全地实施 ,所以LC适应证可以拓宽至 98%以上的有症状胆囊疾病患者。     

腹腔镜胆囊切除术后症状复发的原因探讨

目的:探讨腹腔镜胆囊切除术后症状复发的原因。方法:回顾分析15例单纯腹腔镜胆囊切除术患者术后出现腹痛、黄疸、发热等症状的原因。结果:本组术后1例急性胰腺炎,1例胆总管结石,1例胆总管扩张,1例仅有转氨酶和黄疸指数升高,4例胆囊窝积液,余未见明显异常。患者经系统内科治疗均缓解或治愈。结论:腹腔镜胆囊切除术后症状持续或再现与十二指肠乳头狭窄水肿、胆囊窝炎症、残余结石及胆囊切除术后综合征等有关,一般内科治疗均可缓解。     

Utility of liver function tests after laparoscopic cholecystectomy

Many surgeons routinely obtain liver function tests (LFTs) after all laparoscopic cholecystectomies. Others argue that LFTs provide no useful information and add time and expense to the patient's hospitalization. This purpose of this study was to determine if routine postoperative LFTs predict complications. One hundred ninety-nine consecutive patients undergoing laparoscopic cholecystectomy were included in the analysis. Nine (4.5%) patients had postoperative complications: eight with retained common bile duct stones and one with a cystic duct stump leak. All were diagnosed with postoperative endoscopic retrograde cholangiopancreatography. Only four of the nine patients had hyperbilirubinemia. Overall, 39 patients had postcholecystectomy hyperbilirubinemia, with four (10%) patients having complications (three retained stones and one had a bile leak). For the entire study population, there was no difference between pre- and postoperative total bilirubin and aspartate aminotransferase levels (0.6 vs 0.6 mg/dL; P = 0.623 and 25 vs 41 U/L; P = 0.111, respectively). There was a statistically significant difference in pre- and postoperative alanine aminotransferase and alkaline phosphatase (31 vs 50 U/L; P = 0.003 and 95 vs 90 U/L; P = 0.001, respectively). Postoperative elevations in liver function tests are frequently seen after laparoscopic cholecystectomy. These elevations do not predict postoperative complications. LFTs should be obtained only when clinically indicated.     

腹腔镜胆囊切除术后肝功能变化的原因

目的:探讨腹腔镜胆囊切除术后肝功能变化的原因。方法:将胆囊结石62例患者随机分为2组,A组32例,常规应用电刀切除胆囊,胆囊床普遍电凝处理;B组(对照组)30例,应用弯剪刀分离切除胆囊,钛夹钳闭止血。术后1、3、5、7d抽血测TBIL、ALT、AST、GGT、ALP含量。结果:A组术后第1天TBIL、ALT、AST明显升高,B组无升高,两组差异有显著性(P<0.01),A组术后第3天ALT、AST虽有下降,但仍高出正常值范围,差异仍有显著性(P<0.01),GGT、ALP两组均无明显升高。结论:电热损伤局部肝组织和肝外胆管的热电效应是术后肝功能变化的主要原因。     

腹腔镜胆囊切除术对患者肝功能及C反应蛋白水平的影响

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）与开腹胆囊切除术（open cholecystectomy,OC）两种术式对患者肝功能的影响。方法：随机将慢性胆囊炎合并胆囊结石患者75例分为LC组40例,OC组35例,分别于术前及术后第1、3、5天抽取外周静脉血2ml,检测以下指标：血清总胆汁酸（TBA）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、血清总胆红素（TBIL）、γ-谷氨酸转肽酶（γ-GT）、碱性磷酸酶（ALP）以及C反应蛋白（CRP）。结果：LC组和OC组手术后第1天与第3天TBA、ALT、AST、TBIL及CRP均升高,LC组的CRP升高较OC组更加显著（P〈0.05）。手术后第5天两组各项指标均恢复至正常水平,两组无显著差异。结论：腹腔镜胆囊切除术与开腹胆囊切除术相比,对肝功能的影响无明显差异,实施腹腔镜胆囊切除术安全可行。     

Pulmonary function after laparoscopic and open cholecystectomy

BACKGROUND: Laparotomy causes a significant reduction of pulmonary function, and atelectasis and pneumonia occur after open cholecystectomy. In this prospective, randomized study, we evaluated the hypothesis that pulmonary function is less restricted after laparoscopic cholecystectomy (LC) than after open cholecystectomy (OC). METHODS: Sixty patients underwent laparoscopic (n = 30) or open (n = 30) cholecystectomy. The two groups did not differ significantly in age, sex, intraoperative findings, and preoperative pulmonary function. Pulmonary function tests, arterial blood-gas analysis, and chest radiographs were obtained in both groups before operation and on postoperative day 1. RESULTS: The forced expiratory volume in 1 s (mean +/- SD values; OC, 1.49 +/- 0.77 L/s; LC, 2.33 +/- 0.80 L/s; p > 0.0001) and the forced vital capacity (OC, 2.40 +/- 0.66 L; LC, 2.93 +/- 1.05 L; p > 0.01) were more suppressed in patients having OC than in those having LC. Similar results were found for the peak expiratory flow (OC, 3.51 +/- 1.35 L/s; LC, 4.27 +/- 1.66 L/s; p > 0.05), expiratory reserve volume (OC, 0.73 +/- 0.34 L; LC, 0.92 +/- 0.43 L; p > 0.05), and the midexpiratory phase of forced expiratory flow (FEF25-75) (OC, 1.45 +/- 0.54 L/s; LC, 1.60 +/- 0.73 L/s; NS). Laparoscopic cholecystectomy was associated with a significantly lower incidence of (30 vs 70%) and less severe atelectasis and better oxygenation. CONCLUSION: Pulmonary function is better preserved after LC than after OC.     

Lung function after open versus laparoscopic cholecystectomy

Postoperative lung function and gas exchange were studied in 36 patients after cholecystectomy. Twenty-four of the patients underwent laparoscopic cholecystectomy while the remaining twelve were operated with open technique. Before surgery all patients had normal ventilatory volumes (forced vital capacity, FVC and forced expired volume in 1 s, FEV₁) and normal gas exchange. Two hours postoperativley FVC was reduced to 64±16% (P<0.05) of the preoperative level in the laparoscopic group and to 45±23% (P<0.05) after open cholecystecomy. On the first postoperative day FVC was virtually normal in the laparoscopic patients (77±17% of preoperative level, NS), whereas the open surgery patients still had a decreased FVC (56±13% of preoperative, P<0.05). FEV₁ in the postoperative period followed the same course as FVC. Gas exchange was significantly impaired in the early postoperative period in all patients but no difference between the two groups was found. Two hours postoperatively Pao₂ was reduced to 85% (P<0.05) of preoperative value and Paco₂ had increased by 0.5 kPa (p<0.05). The alveolo-arterial oxygen tension difference (PA-ao₂) had increased by approximately 45% to a mean of 3.7 kPa (P<0.05). On the first postoperative day gas exchange was still significantly impaired in the open surgery patients. Atelectasis detected by computed X-ray tomography of the lungs were found in both groups. However, the amount of atelectasis tended to be smaller in the laparoscopic group than in the open surgery patients. In summary, cholecystectomy irrespective of whether it was performed by open or laparoscopic technique was followed by deterioration in ventilatory function and gas exchange. However, the magnitude of this impairment was less pronounced in laparoscopic cholecystectomy patients than in the open surgery patients which may suggest that this minimal invasive procedure is favourable with respect to postoperative lung function.     

Subcapsular hematoma of the liver after laparoscopic cholecystectomy

Two female patients underwent an uneventful laparoscopic chloecystectomy (LC) for cholelithiasis. Their past medical history was insignificant. The first patient had diclofenac sodium for her postoperative pain relief. Both patients returned in the early postoperative period with pain in the right hypochondrium. Laboratory investigations revealed elevated leucocytes, C reactive protein (CRP), and deranged liver function tests. A computed tomography (CT) scan showed subcapsular haematoma of liver. CT-guided aspiration of hematoma was done in one case. Both patients improved over a period of time and a follow-up radiological scan showed resolving hematoma. The presentation, diagnostic evaluation, treatment, and possible causes are discussed.     

Postoperative pulmonary function after laparoscopic and open cholecystectomy

In this prospective, randomized study, we compared 42 patients undergoing laparoscopic cholecystectomy and 40 undergoing open cholecystectomy to determine if laparoscopic cholecystectomy results in less respiratory impairment and fewer respiratory complications. Pulmonary function tests, arterial blood-gas analysis and chest radiographs were obtained in both groups before operation and on the second day after operation. Postoperative pain scores and analgesic requirements were also recorded. After operation, a significant reduction in total lung capacity, functional residual capacity (FRC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and mid-expiratory flow (FEF25-75%) occurred after both laparoscopic and open cholecystectomy. The reductions in FRC, FEV1, FVC and FEF25-75% were smaller after laparoscopic (7%, 22%, 19% and 23%, respectively) than after open (21%, 38%, 32% and 34%, respectively) cholecystectomy. Laparoscopic cholecystectomy was also associated with a significantly lower incidence (28.6% vs 62.5%) and less severe atelectasis, better oxygenation and reduced postoperative pain and analgesia use compared with open cholecystectomy. We conclude that postoperative pulmonary function was impaired less after laparoscopic than after open cholecystectomy.      

腹腔镜胆囊切除术后患者肝功能及免疫功能的变化

目的:观察腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)对患者肝功能及免疫功能的影响。方法:回顾分析2010年1月至2012年1月为胆囊结石患者行开腹胆囊切除术(open cholecystectomy,OC)(n=65)及LC(n=65)的临床资料,对比两组患者肝功能及免疫功能的变化。结果:两组患者术后血清ALT、AST、TBIL均较术前升高,术后第5天恢复至正常水平。术后第1天、第3天,OC组ALT、AST、TBIL水平明显低于LC组,差异有统计学意义(P<0.05);免疫学指标IgA、IgM、IgG两组患者手术前后均无明显改变,差异无统计学意义(P>0.05)。结论:LC可造成患者肝功能明显升高,但术后可迅速恢复,对免疫功能无影响。