CAJ | 학술논문

目的：探讨不同的气腹压力下行腹腔镜胆囊切除术( LC)对患者胆红素、转氨酶及肩痛的影响。方法选取2012年4月至2014年4月在武汉大学中南医院行采用不同气腹压力性LC的患者130例为研究对象。采用随机数字法分为低压组(65例)和高压组(65例)，高压组气腹压维持在14~16 mmHg(1 mmHg=0．133 kPa)，低压组气腹压维持在8~12 mmHg。比较术前、术后第1日及第3日肝功能指标丙氨酸转氨酶( ALT )、天冬氨酸转氨酶( AST )、总胆红素( TBIL )及直接胆红素( DBIL)的变化。比较肩部疼痛等气腹并发症的发生率。结果 LC术后两组患者血清ALT、AST及TBIL较术前均明显升高(P<0．05)，且高压组患者ALT、AST及TBIL高于低压组(P<0．05)。患者ALT、AST及TBIL在术后第1日明显升高( P <0．05)，第3日均明显下降( P <0．05)。两组患者DBIL术后均无明显改变(P>0．05)。两组患者血清DBIL术后均无明显改变(P>0．05)。高压组患者术后肩部疼痛的发生率(26．2%)明显高于低压组(4．6%)(P<0．05)。结论低气腹压下行LC对患者术后胆红素和转氨酶影响较小，肩痛的发生率较低。
목적：탐토불동적기복압력하행복강경담낭절제술( LC)대환자담홍소、전안매급견통적영향。방법선취2012년4월지2014년4월재무한대학중남의원행채용불동기복압력성LC적환자130례위연구대상。채용수궤수자법분위저압조(65례)화고압조(65례)，고압조기복압유지재14~16 mmHg(1 mmHg=0．133 kPa)，저압조기복압유지재8~12 mmHg。비교술전、술후제1일급제3일간공능지표병안산전안매( ALT )、천동안산전안매( AST )、총담홍소( TBIL )급직접담홍소( DBIL)적변화。비교견부동통등기복병발증적발생솔。결과 LC술후량조환자혈청ALT、AST급TBIL교술전균명현승고(P<0．05)，차고압조환자ALT、AST급TBIL고우저압조(P<0．05)。환자ALT、AST급TBIL재술후제1일명현승고( P <0．05)，제3일균명현하강( P <0．05)。량조환자DBIL술후균무명현개변(P>0．05)。량조환자혈청DBIL술후균무명현개변(P>0．05)。고압조환자술후견부동통적발생솔(26．2%)명현고우저압조(4．6%)(P<0．05)。결론저기복압하행LC대환자술후담홍소화전안매영향교소，견통적발생솔교저。
Objective To explore the effects of different pneumoperitoneum pressures on bilirubin and transaminase and shoulder pain of the patients after laparoscopic cholecystectomy ( LC ) . Methods The patients were chosen from Zhongnan Hospital Affiliated to Wuhan university who received LC under different pneumoperitoneum pressures from Apr. 2012 to Apr. 2014,and they were divided into low pressure group(65 cases) and high pressure group(65 cases) by random number method. The pneumoperitoneum pressure of high pressure group was maintained at 14-16 mmHg(1 mmHg =0. 133 kPa),of low pressure group was maintained at 8-12 mmHg. The alanine aminotransferase( ALT) ,aspartate aminotransferase( AST) ,total bili-rubin( TBIL) and direct bilirubin( DBIL) were compared before the operation and on the first and third day after surgery. The incidence of complications such as shoulder pain was compared. Results The serum levels of ALT,AST and TBIL were significantly elevated after the operation in both groups(P <0. 05),and the three parameters of the high pressure group elevated more apparently(P<0. 05). The serum levels of ALT, AST and TBIL of the two groups were significantly elevated on the first after surgery(P<0. 05),but signifi-cantly decreased on the third day after surgery(P <0. 05). The serum levels of DBIL had no significant differences between the two groups pre-and post-operative(P>0. 05). The rate of the shoulder pain of the high pressure group(26. 2%) was significantly higher than that of the low pressure group(4. 6%)(P <0. 05). Conclusion Low pneumoperitoneum pressure has smaller impact on the bilirubin and transaminase and the incidence of shoulder pain was lower.