婴幼儿先天性巨结肠腹腔镜手术二氧化碳气腹对肝功能影响的临床探讨

目的：观察腹腔镜手术治疗婴幼儿先天性巨结肠术二氧化碳气腹压力对肝功能的影响。方法：30例婴幼儿先天性巨结肠分别在术前、术后2h,术后48h抽外周静脉血进行肝功能检测,检测肝功能各项指标,检测项目有丙氨酸氨基转移酶（ALT）,天门冬氨酸转移酶（AST）,γ-谷氨酰转肽酶（GGT）,血清总胆红素（TBIL）,血清直接胆红素（DBIL）,血清总蛋白（TP）,碱性磷酸酶（ALP）。各项指标经统计学处理。结果：血清总胆红素（TBIL）、血清总蛋白（TP）,碱性磷酸酶（ALP）丙氨酸氨基转移酶（ALT）,γ-谷氨酰转肽酶（GGT）5项指标在术前、术后2h,术后48h3次测量之间的差异有统计学意义（P〈0.05）。血清直接胆红素（DBIL）、天门冬氨酸转移酶（AST）指标在术前、术后2h,术后48h3次测量之间的差异无统计学意义（P〉0.05）。结论：小儿腹腔镜手术治疗婴幼儿先天性巨结肠二氧化碳气腹压力可导致部分肝功能指标出现波动,但波动范围均在正常值内。由于本组病例仅观察48h,近期对肝功能的影响不明显,远期效果有待于进一步观察。

Clinical study on influence of carbon dioxide pneumoperitoneum of infants congenital megacolon by laparoscopic operation for liver function

Objective: To study the influence of carbon dioxide pneumoperitoneum of infants congenital megacolon by laparoscopic operation for liver function. Methods: Thirty infants congenital megacolon were respectively taken peripheral venous blood samples and detected liver function before and after the surgery at 2 hours and 48 hours, the liver function indexes were detected, and the indexes included alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltranspeptidase (GGT), serum total bilirubin (TBIL), serum total protein (TP), alkaline phosphatase (ALP). All the indexes were analyzed. Results: There were significant differences between the three times detection results of serum total bilirubin (TBIL), alanine serum total protein (TP), alkaline phosphatase (ALP), aminotransferase (ALT) andγ-glutamyltranspeptidase (GGT) before and after the surgery at 2 hours and 48 hours (P<0.05), and there were no significant differences between the three times detection results of serum direct bilirubin (DBIL), aspartate aminotransferase (AST) before and after the surgery at 2 hours and 48 hours (P>0.05). Conclusion: The lcarbon dioxide pneumoperitoneum of aparoscopic operation for infants congenital megacolon can cause the some fluctuation of liver function indexes, but fluctuation range is in normal limits. And all the patients are observed in 48 hours, the short-term influence for liver function is not obvious, long-term effect awaits to further observation.