腹腔镜胆囊切除术与开腹胆囊切除术对肝功能影响的比较研究  

Comparison of effects between laparoscopic cholecystectomy and open cholecystectomy on hepatic function in patients with gallbladder diseases

作　　者：智绪亭[1] 张翠生[2] 刘凤军[1] 胡三元[1] 孙凯[1] 董典宁[1] 

机构地区：[1]山东大学齐鲁医院普外科,济南市250012 [2]山东省烟台市毓璜顶医院肝胆外科

出　　处：《中华肝胆外科杂志》2005年第7期470-472,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的对腹腔镜胆囊切除术(LC)与开腹胆囊切除术(OC)手术前后肝功能的临床资料进行对比研究,旨在观察术后肝功能变化规律及两种术式对肝功能的影响有无差异,并为今后手术病例及术式选择提供依据.方法选择胆囊良性病变且肝功能正常需行胆囊切除术者作为研究对象.将30例病人分为LC组和OC组,并分别按开放法或腹腔镜方法实施胆囊切除术.术前、术后第1、3、7天,分别取空腹外周静脉血测定肝功能指标,包括ALT、AST、TBIL、DBIL、GGT、ALB、ALP.结果两组病人年龄构成及术前肝功能无显著差异,LC与OC术后各项指标变化趋势相同.LC与OC术后血清ALT、AST、TBIL均较术前升高;上述指标术后第3天即明显下降,至术后第7天达正常水平,且所有病人术后顺利恢复.LC与OC术后血清ALB均有下降,血清DBIL、GGT、ALP均无显著变化.结论本研究结果表明:(1)LC与OC对肝功能均有影响,但仅为一过性现象,不影响病人恢复;(2)在全麻下,腹腔内气腹压力为12～15 mmHg时,LC对肝功能的影响与OC相比无显著性差异,说明在此情况下施行LC是安全的.Objective To compare the effects between laparoscopic cholecystectomy （LC） and open cholecystectomy （OC） on hepatic function in patients with gallbladder diseases to provide a basis for procedure selection. Methods Based on the selection criteria, 30 patients with benign gallbladder diseases and normal preoperative hepatic function were divided into 2 groups. The 15 patients in group A received LC and the other 15 in group B underwent OC. The peripheral venous blood was sampled before the operation, and on the postoperative day 1, 3 and 7 to determine the serum levels of ALT,AST, TBIL, GGT, ALB and ALP. Results There were no significant differences in age and preoperative hepatic function between the 2 groups. The changing trend of hepatic functional markers was similar in both groups. The serum levels of ALT, AST and TBIL were significantly elevated after the operation in both groups. However, these 3 parameters significantly decreased on the 3rd postoperative day and returned to normal on the 7th postoperative day. Postoperatively, there was marked decrease in serum levels of ALB in both groups, which might be due to the fasting during peri-operative period but not fully caused by the liver damage. Pre- and post-operative comparison showed that there were no remarkable differences in serum levels of DBIL, GGT and ALP between the 2 groups. Conclusions 1） Both LC and OC have negative effects on the hepatic function, but the effects are transient and have on significant impacts on recovery of the patients. 2） Under the condition of intra abdominal pressure of 12-15 mmHg and general anesthesia, the effects of LC on hepatic function is the same to OC, which suggests that LC procedure is safe for the patients with normal or slightly abnormal, hepatic function.

关 键 词：腹腔镜胆囊切除术 开腹胆囊切除术 肝功能 气腹压力 麻醉处理 

分 类 号：R657.4[医药卫生—外科学] R575[医药卫生—临床医学]