不同气腹持续时间对术后患者肝功能影响的临床观察

目的:观察不同二氧化碳气腹持续时间对患者手术后肝脏功能的影响。方法:将40例腹腔镜直肠癌切除术患者根据气腹持续时间分为短时间气腹组(S组,气腹时间在2 h以内,n=20)与长时间气腹组(L组,气腹时间在3 h以上,n=20),术前排除肝肾疾病、结缔组织病及全身免疫性疾病。均采用相同的全身麻醉方法,术中气腹压力为12 mmHg。分别于术前及术后第1天、第3天、第5天、第7天取静脉血,采用酶联免疫法检测患者肝功能。结果:二氧化碳气腹持续时间S组平均(114.3±13.1)min,L组平均(210.6±22.3)min,两组差异有统计学意义(P<0.05)。两组患者术后第1天均出现胆红素轻微升高,但在正常范围内;与S组相比,L组升高较明显(P<0.05)。术后第3天,L组谷丙转氨酶、谷草转氨酶一过性升高(P<0.05),术后第5天降低至正常范围内;S组未出现肝功能相关酶的变化。结论:长时间CO2气腹对患者术后肝功可产生一过性的影响,但较轻微,不影响患者术后康复。

The effects of different duration of carbon dioxide pneumoperitoneum on liver function

Objective： To observe the effect of different duration of carbon dioxide pneumoperitoneum on the hepatic function. Methods： Forty patients undergoing laparoscopic resection for rectal cancer were divided into short time group （ Group S, pneumoperitoneum time less than 2 h, n = 20） and long time group （ Group L, pneumoperitoneum time more than 3 h, n = 20）. Patients with liver and kidney disease, connective tissue disease and systemic autoimmune disease were excluded. The patients used the same anesthesia method, and the pneumoperitoneum pressure was 12 mmHg. The blood sample was collected preoperatively and at 1,3,5,7 d postoperatively respectively to determine and compare the level of total bilirubin （ TBIL）, direct bilirubin （ DBIL）, indirect bilirubin （ IBIL）, alanine aminotransferase （ ALT）, gamma glutamyl transfarase （ GGT）, alkaline phosphatase （ AKP）, aspartate aminotransferase （ AST）, glutamic acid dehydrogenase （GLDH） by enzyme-linked immunosorbent assay. Results： The time of carbon dioxide pneumoperitoneum in Group S were （ 114.3 ± 13.1 ） rain and in Group L were （ 210.6 ±22.3 ） rain （ P 〈 0.05 ）. At day 1 postoperatively, the levels of TBIL and IBIL in Groups S and L increased, but were in normal range, increase in Group L was more significant （ P 〈 0.05 ）. AST and ALT levels increased temporarily on 3rd postoperative day in Group L, then returned to mormal levels on 5th postoperative day. Meanwhile there were no obvious changes in Group S. Conclusions：Long carbon dioxide pneumoperitoneum may result in temporary abnormality of hepatic function in patients, but the extent of that is minimal, has no effect on the recovery of the patients.