腹腔镜胆囊切除术气腹压力、手术时间对肝功能、颈肩痛及恶心呕吐的影响

目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）不同手术时间、气腹压力对肝功能及颈肩痛的影响.方法 选择行择期LC术120例,随机分为3组,每组40例,A组气腹压力设置为10mmHg,B组设置为12mmHg,C组设置为14mmHg;根据手术时间分为D、E、F 3组,每组40例,A组手术时间为小于30min,B组30-60min,C组大于60min,分别对比分析3组患者手术后肝功能、术后当天、第1天、第2天恶心呕吐、颈肩部疼痛发生率.结果 各组患者术前各参数组间比较无显著性意义（P＞0.05）,不同手术时间术后肝功能改变3组间有差异（P＜0.05）,手术时间越长术后AST、ALT、TBIL升高越明显,不同手术时间术后患者出现颈肩痛、恶心呕吐率3组间比较有差异（P＜0.05）,时间越长术后颈肩痛、恶心呕吐发生率越高.不同气腹压力术后肝功能改变3组间有差异（P＜0.05）,气腹压力越大术后AST、ALT、TBIL升高越明显,不同气腹压力术后患者出现颈肩痛、恶心呕吐率3组间比较有差异（P＜0.05）,气腹压力越大术后颈肩痛、恶心呕吐发生率越高.结论 手术时间的长短、气腹压力对术后肝功能、颈肩痛及恶心呕吐有重要影响.

Effects of the time of operation last and different CO2 pneumoperitioneum pressure on hepatic function,nausea and shoulder pain following laparoscopic cholecystectomy

Objective To investigate the effects of operation time,different CO2 pneumoperitioneum pressure on hepatic function,nausea and shoulder pain following laparoscopic cholecystectomy. Methods One hundred and twenty patients under went laparoscopic cholecystectomy were randomly divided into three groups with 40 patients in each group, the CO2 pneumoperitioneum pressure was set at 10mmHg in the group A, 12mmHg in the group B and 14mmHg in the group C. These patients were divided into three group based on length of operation time last, less than 30 minutes in the group D, from 30 to 60 minutes in the group E and lengther than 60 minutes in the group F. Analysis the hepatic function, nausea and shoulder pain after laparoscopic cholecystectomy. Results The significant difference was found in the hepatic function,nausea and shoulder pain after laparo-scopic cholecystectomy in these groups（P〈0.05）.The higher the pneumoperitioneum pressure,the higher the AST,ALT,TBIL, and higher the rate of nausea and shoulder pain.The lengther the operation time last, the higher the AST,ALT,TB1L,the same to the rate of nausea and shoulder pain after laparoscopic cholecystectomy. Conclusion The CO2 pneumoperitioneum pressure and the time of operation last has a significant effects on hepatic function,nausea and shoulder pain following laparoscopic cholecystecto- my.