手术体位对腹腔镜胆囊切除术肝功能的影响.DOCVIP

临床医学论文-手术体位对腹腔镜胆囊切除术肝功能的影响 ??????????? 作者：陆昌友，黄君，林琦远，但小红，郭卫昌 【摘要】? 目的：研究腹腔镜胆囊切除术中不同手术体位对肝功能的影响。方法：随机将100例患者分为A、B、C三组,手术体位采用固定左倾2０°，分别取头高足低15°、３０°、４５°体位，比较术后肝功能的变化情况。结果：３组患者术后ld肝功能均明显升高（P＜00１），但A、C组比B组损害严重（P＜00５）。术后3d肝功能均有明显下降,但仍高于术前,且B组恢复最快。结论：LC中不同手术体位与术后肝功能损害有相关，手术体位是引起肝功能损害的因素之一。 　　【关键词】? 肝功能；胆囊切除术，腹腔镜；手术体位 　　Influence of the different surgical position on human hepatic function after laparoscopic cholecystectomy 　　【Abstract】? Ｏbjective:To investgate the influence of different surgical positon on human hepatic funcfion after laparoscopic cholecystectomy(LC).Methods:A total of 100 patients who undergoing LC were randomized into there groups(groups A,B and C).The position of operation of all the patients were at an angle of declination by 20 degree to the left.Three groups were trendelenburg position and were at an angle of declination by 15,30,45 degree accordingly.The changes in hepatic function after the operation were compared among there groups.Results:The levels of hepatic function were significantly increased on 1 day after operation in the three groups（P＜0.0１）and that of group A and group C increased more than that in group B（P＜0.0５）.The level of hepatic function of all the patients were decreased on 3 day after operation,but remained still higher.The recovery duration of group B was the shortest among the three groups.Conclusions:Different surgical position relates to the damage of human hepatic function after LC.The surgical position is one of factors which caused the damage of hepatic function. 　　【Key words】? Hepatic function;Cholecystectomy,laparoscopic;Surgical position 　　研究发现，腹腔镜胆囊切除术（ＬＣ）对患者肝功能有不同程度的损害［１，２］，腹腔镜常须借助某些特殊的体位来改善术野的显露,这些特殊的体位可能给机体带来不良的影响,并可能造成一系列的并发症［３］。目前手术体位对LC肝功能影响的研究尚未见报道,现将我们的研究结果报道如下。 　　1? 资料与方法 　　11? 临床资料? 选择２００５年３月～９月我院收治的慢性胆囊炎伴胆囊结石患者１００例,男４２例，女58例,２４～５３岁,平均42岁。患者既往均无黄疸、胰腺炎、严重感染及免疫系统疾病史,术前检查心、肺、肝、肾功能均在正常范围,乙肝表面抗原阴性。随机分为３组,A组33例,B组34例,C组33例。 　　12? 手术方法? 所有患者的LC均固定同一组手术人员,采用统一麻醉药物处方,静脉复合全麻气管内插管,采用“三孔”技术,全部患者CO2气腹压设置在１１mm Hg。LC手术体位采