Morino M, Giraudo G, Festa V
Dipartimento di Discipline Medico-Chirurgiche dell'Università di Torino, Clinica Chirurgica Generale e Oncologica, C.so A.M. Dogliotti, 14, 10126 Torino, Italy.
Surg Endosc. 1998 Jul;12(7):968-72. doi: 10.1007/s004649900758.
Very few studies have been done on the consequences of pneumoperitoneum on hepatic function. At present, there is no consensus on the physiopathological hepatic implications of pneumoperitoneum. The purpose of this clinical study was to evaluate the effects of pneumoperitoneum on hepatic function in 52 patients treated with laparoscopic procedures.
Thirty-two laparoscopic cholecystectomies and 20 nonhepatobiliary laparoscopic procedures were performed in 52 patients (12 men and 40 women) with a mean age of 44 years (range, 15-74). All patients had normal values on preoperative liver function tests. The anesthesiologic protocol was uniform, with drugs at low hepatic metabolism. The 32 cholecystectomies were randomized into 22 performed with pneumoperitoneum at 14 mmHg and 10 performed at 10 mmHg. All nonhepatobiliary laparoscopic procedures were performed with a pneumoperitoneum of 14 mmHg. The postoperative serologic levels of AST, ALT, bilirubin, and prothrombin time were measured at 6, 24, 48, and 72 h. The serologic changes were related to the procedure, the duration, and the level of pneumoperitoneum.
Mortality and morbidity were nil. All 52 patients had a postoperative increase in AST, ALT, bilirubin, and lengthening in prothrombin time. Slow return to normality occurred 48 or 72 h after operation. The increase of AST and ALT was statistically significant and correlated both to the level (10 versus 14 mmHg) and the duration of pneumoperitoneum.
The duration and level of intraabdominal pressure are responsible for changes of hepatic function during laparoscopic procedures. Although no symptom appears in patients with normal hepatic function, patients with severe hepatic failure should probably not be subjected to prolonged laparoscopic procedures.
关于气腹对肝功能影响的研究非常少。目前，对于气腹在肝脏生理病理方面的影响尚无共识。本临床研究的目的是评估气腹对52例行腹腔镜手术患者肝功能的影响。
对52例患者（12例男性，40例女性）进行了32例腹腔镜胆囊切除术和20例非肝胆腹腔镜手术，平均年龄44岁（范围15 - 74岁）。所有患者术前肝功能检查值均正常。麻醉方案统一，采用低肝代谢药物。32例胆囊切除术随机分为22例采用14 mmHg气腹压力进行，10例采用10 mmHg气腹压力进行。所有非肝胆腹腔镜手术均采用14 mmHg气腹压力。分别在术后6、24、48和72小时测量血清AST、ALT、胆红素水平及凝血酶原时间。血清学变化与手术方式、手术时长和气腹压力水平相关。
无死亡和并发症发生。所有52例患者术后AST、ALT、胆红素均升高，凝血酶原时间延长。术后48或72小时缓慢恢复正常。AST和ALT的升高具有统计学意义，且与气腹压力水平（10 mmHg与14 mmHg）和气腹持续时间均相关。
腹腔镜手术期间，腹腔内压力的持续时间和水平是导致肝功能变化的原因。虽然肝功能正常的患者未出现症状，但严重肝功能衰竭患者可能不应接受长时间的腹腔镜手术。
