Lai Hao, Mo Xianwei, Yang Yang, Xiao Jun, He Ke, Chen Jiansi, Lin Yuan
Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
Department of Neck and Head Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
PLoS One. 2014 Aug 11;9(8):e104067. doi: 10.1371/journal.pone.0104067. eCollection 2014.
The aim of this study is to accurately assess whether the duration of intraoperative carbon dioxide pneumoperitoneum (CDP) is associated with the induction of hepatic injury.
We conducted a systematic review of PubMed, Embase, and Cochrane Library databases (through February 2014) to identify case-match studies that compared high-pressure CDP with low-pressure CDP or varied the duration of CDP in patients who underwent abdominal surgery. The outcome of interest was postoperative liver function (ALT, AST, TB).
Eleven comparative studies involving 2,235 participants were included. Overall, levels of ALT, AST, and TB (on postoperative days 1, 3, and 7) were significantly elevated in the study groups. However, the results of the subanalyses of those who underwent laparoscopic colorectal cancer resection (LCR) versus open colorectal cancer resection (OCR) and those who underwent laparoscopic gastric bypass (LGBP) versus open gastric bypass (OGBP) were inconsistent.
The current evidence suggests that the duration of CDP during laparoscopic abdominal surgery may be associated with hepatic injury. Additional large-scale, randomized, controlled trials are urgently needed to further confirm this.
本研究旨在准确评估术中二氧化碳气腹（CDP）的持续时间是否与肝损伤的发生有关。
我们对PubMed、Embase和Cochrane图书馆数据库进行了系统回顾（截至2014年2月），以确定病例对照研究，这些研究比较了接受腹部手术患者的高压CDP与低压CDP，或改变了CDP的持续时间。感兴趣的结局是术后肝功能（ALT、AST、TB）。
纳入了11项涉及2235名参与者的比较研究。总体而言，研究组中ALT、AST和TB水平（术后第1、3和7天）显著升高。然而，接受腹腔镜结直肠癌切除术（LCR）与开腹结直肠癌切除术（OCR）以及接受腹腔镜胃旁路术（LGBP）与开腹胃旁路术（OGBP）患者的亚分析结果并不一致。
目前的证据表明，腹腔镜腹部手术期间CDP的持续时间可能与肝损伤有关。迫切需要更多大规模、随机、对照试验来进一步证实这一点。
