腹腔镜辅助胃癌根治术后肝功能变化及其影响因素

目的评估腹腔镜辅助胃癌根治术后患者肝功能变化并分析其有关影响因素。方法收集2008年6月至2010年6月期间在解放军总医院行胃癌根治术及结肠癌根治术病例的临床资料,分为开腹胃癌根治术组(OG组,n=43)、腹腔镜辅助胃癌根治术组(LAG组,n=35)以及腹腔镜辅助结肠癌根治术组(LAC组,n=23),比较各组患者术前及术后第1、3、5和7天血清AST、ALT、TB和ALP水平变化并分析其相关的影响因素。结果 LAG组和OG组患者术后5 d内血清AST和ALT水平均较术前明显增高(P<0.05),LAC组患者术后未观察到肝功能的变化(P>0.05);除术后第1天LAG组血清AST和ALT水平显著高于OG组(P=0.035和P=0.041)和术后第3天LAG组血清ALT水平显著低于OG组(P=0.048)外,2组在其余时间点血清AST和ALT水平的差异无统计学意义(P>0.05);LAG组患者术后5 d内血清AST和ALT水平均较LAC组为高(P<0.05)。LAG组和OG组患者术前及术后血清TB和ALP水平无明显变化(P>0.05)。胃癌患者术后血清ALT水平升高与体重指数(P=0.038)、手术时间(P=0.011)、术中肝损伤(P=0.035)以及入肝血流的异常阻断(P=0.048)有关,而与手术方式无关(OG比LAG,P>0.05)。结论胃癌根治术后患者均有一过性肝功能损害,而造成腹腔镜辅助胃癌根治术后患者肝功能异常的原因可能与术中对肝脏的牵拉和损伤以及对入肝血流的异常阻断有关,而非CO2气腹的影响。对于无严重肝功能损害或其他重要脏器疾患的患者来说,腹腔镜辅助胃癌根治术是安全、可行的。

Liver Function Alterations and Its Influencing Factors after Laparoscopic-Assisted Radical Gastrectomy for Gastric Cancer

Objective To evaluate the changes of liver function after laparoscopic-assisted radical gastrectomy for gastric cancer and analyze related impact factors.Methods Patients with gastric cancer or colon cancer,who underwent radical gastrectomy or hemicolectomy between Jun 2008 and Jun 2010 in General Hospital of PLA,were included in this study.These patients were divided into open gastrectomy(OG group,n=43),laparoscopic-assisted gastrectomy(LAG group,n=35),and laparoscopic-assisted hemicolectomy(LAC group,n=23).The serum AST,ALT,TB,and ALP levels of all patients enrolled on the preoperative day and post operative day(POD) 1,POD3,POD5,and POD7,and related impact factors were analyzed.Results Compared with the preoperative results,serum AST and ALT levels of patients increased until POD5 in both LAG and OG groups(P<0.05),and there was no changes in liver function after operation of patients in LAC group(P>0.05).In addition to that serum AST and ALT levels of patients in LAG group in POD1 were significantly higher than those in OG group(P=0.035 and P=0.041),and that serum ALT level of patients in LAG group was significantly lower than that in OG group in POD3(P=0.048),serum AST and ALT levels of patients in two groups in the remaining time points were not statistically significant difference(P>0.05).The serum AST and ALT levels of patients in LAG group were significantly higher than those in LAC group during 5 d after operation(P<0.05). There was no significant changes of serum ALP and TB levels of patients in LAG and OG groups on the before and after operation(P>0.05).The increased serum ALT level of gastric cancer patients after operation related to body mass index(BMI,P=0.038),operative time(P=0.011),intraoperative hepatic injury(P=0.035),and abnormal ligation of hepatic artery(P=0.048),instead of the type of operation(OG vs.LAG,P>0.05).Conclusions Gastric cancer patients who underwent radical gastrectomy have transient liver dysfunction,which attributes mainly to direct liver manipulation or abnormal ligation of hepatic artery,but not CO2 pneumoperitoneum.Laparoscopic-assisted radical gastrectomy is feasible and safe to the patients without serious liver damage or other vital organs disorders.