高高原地区腹腔镜胆囊切除术对患者肝功能及炎症因子的影响
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摘要
目的:研究海拔4500m的高高原地区低氧条件下,腹腔镜胆囊切除术(LC)与传统开腹胆囊切除术(OC)对患者术后肝功能及炎症因子的影响。方法:将西藏阿里地区人民医院收治的88例胆囊结石患,随机分为LC组(42例)和OC组(46例),分别分析两组患者术后第1天和第5天肝功能(ALT、AST、ALP、TBIL)及炎症因子(CRP、IL-6、IL-8)指标的变化。结果:两组患者术后第1天的ALT、AST、TBIL均比本组术前升高,而ALP低于术前,差异有统计学意义(P<0.05),至术后第5天均恢复至术前水平(P>0.05);术后第1天、第5天两组间的肝功能指标差异无统计学意义(P>0.05)。两组患者术后第1天的炎症因子水平均较本组术前升高,差异有统计学意义(P<0.05);至术后第5天LC组炎症因子仍高于本组术前(P<0.05),OC组炎症因子已恢复至本组术前水平(P>0.05),LC组与OC组间,术后第1天及第5天的炎症因子比较,差异有统计学意义(P<0.05)。结论:LC与OC都会使患者肝功能下降,并使炎症因子水平升高,但对炎症因子的影响LC比OC影响更大。但LC的应用较为广泛,其对腹壁的创伤小,利于恢复,高高原地区亦可以推广相应手术。
Objective:To study the effects of liver function and inflammatory factors by laparoscopic cholecystectomy(LC)and conventional open cholecystectomy(OC)on high altitude area,respectively.Methods:Eightyeight patients with gallstones were collected into this study.88 cases with gallstones were random divided into two groups,LC group(42 cases)and OC group(46 cases).To study the effects of liver function index(ALT,AST,ALP,TBIL)and inflammatory factors(CRP,IL-6,IL-8)at 1 st day and 5 th days after operation in two groups,respectively.Results:Liver function index(ALT,AST and TBIL)levels of two groups were show significantly higher at the 1 st postoperative day than those in the preoperative.But ALP was show lower than before surgery(P<0.05).Liver function index levels were recovered to preoperative levels at 5 th days after operation(P>0.05).Liver function index were show no significant difference between the two groups at 1 st day and 5 th days after operation(P>0.05).For the levels of Inflammatory factors(CRP,IL-6 and IL-8)were significantly higher than those before surgery in two groups,respectively(P<0.05).The levels inflammatory factors in the LC group were still higher than those in the preoperative at 5 th days after operation(P<0.05).But the levels of inflammatory factors in the OC group were recovered to preoperative levels at 5 th days after operation(P>0.05).The levels of Inflammatory factors were show significant difference between the two groups at 1 st day and 5 th days after operation(P<0.05).Conclusions:Both LC and OC decrease liver function and increase the level of inflammatory cytokines,but the effect of LC on inflammatory factors is greater than that of OC.LC surgery has little trauma to the abdominal wall compared with OC surgery.LC operation can be promoted in high altitude areas.
Objective:To study the effects of liver function and inflammatory factors by laparoscopic cholecystectomy(LC)and conventional open cholecystectomy(OC)on high altitude area,respectively.Methods:Eightyeight patients with gallstones were collected into this study.88 cases with gallstones were random divided into two groups,LC group(42 cases)and OC group(46 cases).To study the effects of liver function index(ALT,AST,ALP,TBIL)and inflammatory factors(CRP,IL-6,IL-8)at 1 st day and 5 th days after operation in two groups,respectively.Results:Liver function index(ALT,AST and TBIL)levels of two groups were show significantly higher at the 1 st postoperative day than those in the preoperative.But ALP was show lower than before surgery(P<0.05).Liver function index levels were recovered to preoperative levels at 5 th days after operation(P>0.05).Liver function index were show no significant difference between the two groups at 1 st day and 5 th days after operation(P>0.05).For the levels of Inflammatory factors(CRP,IL-6 and IL-8)were significantly higher than those before surgery in two groups,respectively(P<0.05).The levels inflammatory factors in the LC group were still higher than those in the preoperative at 5 th days after operation(P<0.05).But the levels of inflammatory factors in the OC group were recovered to preoperative levels at 5 th days after operation(P>0.05).The levels of Inflammatory factors were show significant difference between the two groups at 1 st day and 5 th days after operation(P<0.05).Conclusions:Both LC and OC decrease liver function and increase the level of inflammatory cytokines,but the effect of LC on inflammatory factors is greater than that of OC.LC surgery has little trauma to the abdominal wall compared with OC surgery.LC operation can be promoted in high altitude areas.
引文
[1]程启芳,唐万旭.亚高原地区腹腔镜手术二氧化碳气腹对呼吸和循环功能的影响[J].中国基层医药,2012,19(4):600-601.
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[4]蒲东利,秦斌,杜子友,等.高原地区开展腹腔镜胆囊切除术348例治疗体会[J].临床外科杂志,2009,17(6):424-425.
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[6]杨雪松.腹腔镜与开腹胆囊切除术对患者肝功能及免疫功能影响对比研究[J].中外医疗,2014,33(3):70-72.
[7]赵燕.腹腔镜胆囊切除术围手术期护理措施分析[J].临床合理用药杂志,2014,7(8):142-143.
[8]曲涛.腹腔镜与传统开腹胆囊切除术对患者肝功能及免疫功能的影响[J].中国现代医生,2014,52(32):22-24.
[9]张小斌,周毅,张将,等.腹腔镜胆囊切除术气腹对糖尿病患者术后肝功能的影响[J].中国医学创新,2015,12(30):57-60.
[10]余伦,张钧,焦勇,等.腹腔镜与开腹胆囊切除术对患者肝功能、免疫功能及炎症因子的影响[J].海南医学院学报,2016,22(1):59-61,65.
[2]Oyogoa A,Sylvanus O,Komenaka A,et al.Mini-laparotomy cholecystectomy in the era of laparoscopic cholecystectomy:a community-based hospital perspective[J].American Surgeon,2003,69(7):604-607.
[3]蒙禧增,赵至成,仲小舟,等.高原条件下腹腔镜胆囊切除术气腹对呼吸系统功能的影响[J].临床军医杂志,2009,37(5):882-883.
[4]蒲东利,秦斌,杜子友,等.高原地区开展腹腔镜胆囊切除术348例治疗体会[J].临床外科杂志,2009,17(6):424-425.
[5]吴立华.腹腔镜手术对卵巢囊肿患者应激代谢的影响[J].中国妇幼保健,2011,26(32):5083-5084.
[6]杨雪松.腹腔镜与开腹胆囊切除术对患者肝功能及免疫功能影响对比研究[J].中外医疗,2014,33(3):70-72.
[7]赵燕.腹腔镜胆囊切除术围手术期护理措施分析[J].临床合理用药杂志,2014,7(8):142-143.
[8]曲涛.腹腔镜与传统开腹胆囊切除术对患者肝功能及免疫功能的影响[J].中国现代医生,2014,52(32):22-24.
[9]张小斌,周毅,张将,等.腹腔镜胆囊切除术气腹对糖尿病患者术后肝功能的影响[J].中国医学创新,2015,12(30):57-60.
[10]余伦,张钧,焦勇,等.腹腔镜与开腹胆囊切除术对患者肝功能、免疫功能及炎症因子的影响[J].海南医学院学报,2016,22(1):59-61,65.