Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey.
Clinic of Surgical Oncology, University of Health Sciences, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
Pol Przegl Chir. 2021 Oct 17;94(1):54-61. doi: 10.5604/01.3001.0015.3544.
There are very few studies in the literature investigating the changes caused by the Nathanson retractors in liver function tests (LFT) after LG and its clinical significance. The present study investigated the changes made by the Nathanson retractor used during LG on LFT and its clinical significance.
The data of 236 patients, who underwent radical gastrectomy for primary gastric cancer at Surgical Oncology Unit in the period between January 2015 and January 2020 were retrospective studied. The patients were divided into two groups: laparoscopic gastrectomy (LG; 136 cases) and open gastrectomy (OG; 106 cases). Patients who have undergone cholecystectomy, with primary or secondary liver tumors, with chronic hepatic disease, who have preoperative high ALT, AST and bilirubin values were excluded from the study. LFT were measured preoperatively and postoperative day 1 (LFT1), LFT3, LFT5 and LFT7. LFT: ALT, AST and Total bilirubin (BIL).
ALT1, ALT3, ALT5, ALT7 ALT values and AST1, AST3, AST5 AST values of the patients in the LG group were found to be significantly higher (P <0.001). Mean total bilirubin values of the groups were similar (P >0.05). In order to evaluate how the increase in LFT due to the use of the Nathanson retractors reflected on the patients' clinic, we divided the patients who underwent LG into two groups based on ALT increase in ALT1: Normal and Elevated. The in-hospital mortality rates (P = 0.080) and oral nutrition time (P = 0.913) of the groups were similar. No liver infarction developed in any of the groups. The duration of stay in the ICU was significantly longer in individuals with elevated LFT (P = 0.019).
Although the use of the Nathanson retractor during LG causes an increase in liver function tests, this does not cause major clinical problems in patients. Key Words: Gastrectomy; gastric cancer; laparoscopy; liver enzymes; liver dysfunciton.
文献中很少有研究调查 Nathanson 牵开器在腹腔镜胃切除术后（LG）对肝功能试验（LFT）的影响及其临床意义。本研究调查了 Nathanson 牵开器在 LG 中对 LFT 的影响及其临床意义。
回顾性研究了 2015 年 1 月至 2020 年 1 月期间在外科肿瘤学单位接受原发性胃癌根治性胃切除术的 236 名患者的数据。将患者分为两组：腹腔镜胃切除术（LG；136 例）和开腹胃切除术（OG；106 例）。排除行胆囊切除术、原发性或继发性肝肿瘤、慢性肝病、术前 ALT、AST 和胆红素值高的患者。测量术前（LFT1）和术后第 1 天（LFT3）、第 3 天（LFT5）和第 7 天（LFT7）的 LFT：ALT、AST 和总胆红素（BIL）。
LG 组患者的 ALT1、ALT3、ALT5、ALT7 ALT 值和 AST1、AST3、AST5 AST 值明显升高（P <0.001）。各组总胆红素值相似（P >0.05）。为了评估 Nathanson 牵开器的使用引起的 LFT 升高如何反映在患者的临床中，我们根据 ALT1 中 ALT 的升高将接受 LG 的患者分为两组：正常和升高。两组的住院死亡率（P = 0.080）和口服营养时间（P = 0.913）相似。两组均未发生肝梗死。LFT 升高者 ICU 停留时间明显延长（P = 0.019）。
尽管 Nathanson 牵开器在 LG 中使用会导致肝功能试验升高，但这不会给患者带来重大临床问题。关键词：胃切除术；胃癌；腹腔镜检查；肝酶；肝功能障碍。
