Etoh Tsuyoshi, Shiraishi Norio, Tajima Masaaki, Shiromizu Akio, Yasuda Kazuhiro, Inomata Masafumi, Kitano Seigo
Department of Surgery I, Oita University Faculty of Medicine, 1-1 Hasama-machi, Oita, 879-5593, Japan.
World J Surg. 2007 May;31(5):1115-20. doi: 10.1007/s00268-007-0237-3.
The effect of laparoscopic surgery under CO2 pneumoperitoneum on liver function is not clear. The aim of this study was to clarify whether laparoscopy-assisted distal gastrectomy (LADG) is associated with changes in liver function compared with open distal gastrectomy (ODG).
A total of 205 patients who underwent LADG (n = 147) or ODG (n = 58) between January 1994 and April 2004 were included in this study. Liver function tests-aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total bilirubin-were examined before surgery and at 1, 3, and 7 days after surgery. The postoperative clinical course was compared between the two groups.
AST levels on day 1 and ALT levels on days 1 and 3 were significantly higher in the LADG group. Albumin levels showed a marked decrease after operation in both groups, but the level recovered more rapidly in the LADG group than in the ODG group, showing significant differences on days 3 and 7. The total bilirubin levels remained unchanged from baseline. The postoperative complication rate was similar in the two groups, although 3 LADG patients among the 27 patients with liver disease suffered severe enteritis.
Transient liver dysfunction was documented in patients after laparoscopic gastrectomy under CO2 pneumoperitoneum.
二氧化碳气腹下腹腔镜手术对肝功能的影响尚不清楚。本研究的目的是阐明与开腹远端胃癌切除术（ODG）相比，腹腔镜辅助远端胃癌切除术（LADG）是否与肝功能变化有关。
本研究纳入了1994年1月至2004年4月期间接受LADG（n = 147）或ODG（n = 58）的205例患者。在手术前以及手术后第1、3和7天检查肝功能指标——天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、白蛋白、总胆红素。比较两组患者术后的临床病程。
LADG组术后第1天的AST水平以及术后第1天和第3天的ALT水平显著更高。两组患者术后白蛋白水平均显著下降，但LADG组的水平恢复速度比ODG组更快，在术后第3天和第7天显示出显著差异。总胆红素水平与基线相比保持不变。两组术后并发症发生率相似，尽管27例肝病患者中有3例LADG患者发生了严重肠炎。
二氧化碳气腹下腹腔镜胃癌切除术后患者出现了短暂性肝功能障碍。
