【摘要】 目的:对不同CO2气腹压对高海拔地区行腹腔镜胆囊切除术前后患者肝功能的影响进行对比研究,探讨高海拔地区低气腹压行腹腔镜手术的可行性。方法:在高海拔地区选择90例慢性胆囊疾病患者,行腹腔镜胆囊切除术,根据术中气腹内压的不同,分为三组:低气腹压10mm Hg组、中气腹压12mm Hg组、高气腹压14mm Hg组,分别在术前1天、术中0.5h、术后第1、3、5天,取空腹外周静脉血测定肝功能各项指标,包括谷丙转氨酶、谷草转氨酶、碱性磷酸酶、总胆红素、直接胆红素、间接胆红素。术中分别取三组患者少许肝组织(气腹作用时间点相同取肝组织),分别测定过氧化产物丙二醛(MDA)、超氧化物歧化酶(SOD)、还原性谷胱甘肽(GSH)、过氧化氢酶(CAT)活性。结果:90例患者均顺利完成腹腔镜下胆囊切除术,三组患者年龄构成及术前肝功能无明显差别,在海拔3 300m左右的青藏高原地区,CO2气腹压是行腹腔镜胆囊切除术后患者引起肝功能变化的主要因素,10mm Hg的气腹压对肝功能无明显影响,气腹压力越高,对肝功能的影响越明显,持续时间越长,尤其以谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素较为显著,且以术后第三天最为显著,而对碱性磷酸酶、间接胆红素无显著影响;术中0.5小时,三组各项指标相比均无明显差异;与低气腹压组和中气腹压组相比,高气腹压组患者肝细胞内MDA活性显著增高,而SOD、GSH、CAT活性显著降低。结论:在高海拔地区地区行腹腔镜胆囊切除术,气腹压应选择与平原地区有区别,应选用低气腹压力值。更多还原

【Abstract】 Objective: To explore the feasibility of low pneumoperitoneum pressure used in laparoscopic cholecystectomy( LC) at high altitudes,By observing the effects of different CO2 pneumoperitoneum pressures on the patients’ hepatic function following LC in plateau region. Methods: Based on the criteria,90 patients with chronic gallbladder diseases were selected and undergoing LC,According to the difference of different CO2 pneumoperitoneum pressure during the operation,These patients were randomly divided into three groups: low pneumoperitoneum( LP) pressure with 10 mm Hg of CO2; middle pneumoperitoneum( MP) pressure with 12 mm Hg of CO2 and high pneumoperitoneum( HP) pressure with 14 mm Hg of CO2. Then the venous blood was collected at 1d before operation and half an hour in the operation and at 1d,3d and 5d after operation,Comparing the changes of hepatic function of the three groups following LC,including ALT,AST,ALP,TBIL,DBIL and IBIL. A small amount of liver tissue was taken during the operation from different group in order to test the activity of MDA,SOD,GSH and CAT in these tissue. Results: 90 patients were successfully completed LC. The age composition and preoperative liver function of patients in three groups had no obvious difference. At an altitude of 3 300 meters of the Qinghai- Tibet plateau area,Pneumoperitoneum pressure was the main factor of liver function changing. But the patients who accepted laparoscopic surgery,10 mm Hg of pneumoperitoneum pressure showed no obvious effect on liver function. The much the pneumoperitoneum pressure was higher,the more obvious effects on liver function and the longer the duration,especially in ALT,AST,TBIL,DBIL. And on the third day after surgery was the most significant. The pneumoperitoneum pressure had no significant effect on the levels of ALP and IBIL. There had no obvious difference on half an hour after the operation in patients’ liver function of the three groups. Compared with LP group and MP group,MDA in HP showed significant higher activity,but SOD,GSH and CAT activity decreased significantly.Conclusion: The appropriate pneumoperitoneum pressure selection should differ from the plains during the laparoscopic cholecystectomy at high altitudes. LP pressure( 10 mm Hg of CO2) can significantly reduce the impact on the liver function during the LC.更多还原