Neri Vincenzo, Ambrosi Antonio, Fersini Alberto, Tartaglia Nicola, Cianci Pasquale, Lapolla Francesco, Forlano Immacolata
Ann Ital Chir. 2014 Sep-Oct;85(5):431-7.
The changes in liver function tests (LFTs) after laparoscopic cholecystectomy (LC) have been described in the literature. The aims of this study are to value the increases of the LFTs and its clinical appearance after LC. Furthermore we studied the correlation of the changes of LFTs with the operative time and the role of elevated BMI.
In the period October 2012 - May 2013, 81 patients undergone to elective LC were analyzed by examining bilirubin, AST, ALT, ALP, GGT at the admission, 1 and 3 days after surgery. Correlations of the length of intervention and BMI with changes of LFTs are evaluated. During surgery, the intrabdominal pressure has been 12 mmHg in all patients. The Student t test, PCC (Pearson's correlation coefficient) OR (odds ratio) were performed to determine statistical significance.
The level of (serum) AST, ALT increased significantly during 24-48 hours after LC (p < 0,0001). The increase of (total and direct) bilirubin has not the statistical significance. On the contrary ALP, GGT was significantly decreased (p < 0,001). Three days after surgery LFTs returned to normal level in the patients with previous normal level of tests. The length of intervention doesn't show correlations with changes of LFTs (PCC 0.2). the BMI >28 led increased risk of changes of LFTs (OR 2.44).
The changes of LFTs are transient and clinically silent in patients with a normal liver function. Nevertheless must be evaluated preoperative BMI and liver dysfunction.
文献中已描述了腹腔镜胆囊切除术（LC）后肝功能检查（LFTs）的变化。本研究的目的是评估LC后LFTs的升高情况及其临床表现。此外，我们研究了LFTs变化与手术时间的相关性以及高体重指数（BMI）的作用。
在2012年10月至2013年5月期间，对81例行择期LC的患者在入院时、术后1天和3天进行胆红素、谷草转氨酶（AST）、谷丙转氨酶（ALT）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）检查进行分析。评估干预时间长度和BMI与LFTs变化的相关性。手术期间，所有患者的腹腔内压力均为12 mmHg。采用学生t检验、皮尔逊相关系数（PCC）、比值比（OR）来确定统计学意义。
LC后24 - 48小时内（血清）AST、ALT水平显著升高（p < 0.0001）。（总胆红素和直接胆红素）的升高无统计学意义。相反，ALP、GGT显著降低（p < 0.001）。术前LFTs水平正常的患者术后3天LFTs恢复至正常水平。干预时间长度与LFTs变化无相关性（PCC 0.2）。BMI>28会增加LFTs变化的风险（OR 2.44）。
肝功能正常的患者LFTs变化是短暂的且临床上无明显症状。然而，术前必须评估BMI和肝功能障碍情况。
