摘要
目的 研究腹腔镜胆囊切除术 (LC)术后血清ALT、AST水平变化的原因。 方法 随机将 1999年 10月我院收治的 6 9例胆囊结石患者分为A组 35例 ,单极电刀切除胆囊 ,胆囊床普遍电凝处理 ,B组 34例 (对照组 )剪刀切除胆囊 ,钛夹钳闭止血。手术结束时抽样取两组病人胆囊床底部边缘肝组织 1cm× 1cm一块 ,全部受试者术后 1、5天抽血测定血清ALT、AST含量 ,数据均经统计学处理。 结果 A组 (电切 )术后 1天血清ALT、AST水平显著升高 ,与B组 (剪切 )相比 ,差异有显著性意义 (P <0 0 1)。肝活检标本病理组织学光镜观察 ,电刀接触面肝细胞发生电凝固性坏死 ,其内层肝细胞皱缩 ,深层 (约 1cm)肝细胞变性水肿 ;剪刀切除胆囊组肝细胞正常。 结论 LC术中电刀对局部肝组织热损伤是术后早期血清ALT。
Objective To investigate the reasons for the changes of serum ALT, AST after laparoscopic cholecystectomy. Methods 69 patients admitted in Oct, 1999 were randomly divided into two groups. The gallbladder was resected with monopolar cautery laparoscopically and cystic bed was routinely coagulated in 35 patients, group a. The gallbladder was removed with microscissors and the cystic artery was clipped with titanium clip in 34 patients, group B. Hepatic tissue in bulk of 1cm X 1cm and close to the gallbladder bed was sampled for histological study for all patients in the two groups. The serum ALT and AST levels were measured on the 1st, 5th ,postoperative day. Results Comparing with group B, the serum ALT and AST levels in group A were significantly higher on the 1th postoperative day ( P <0 01). Coagulative necrosis of hepatocytes on the plane contacting cautery directly was observed under microscope, while shrinkage of hepatocytes on the second plane and degeneration, edema of the hepatocytes on the third plane were noted. Liver cells from the group B showed normal. Conclusions Heat injury to the liver tissue is a major reason for increased serum ALT and AST level in the initial stage after operation.
出处
《中国微创外科杂志》
CSCD
2001年第3期141-142,F003,共3页
Chinese Journal of Minimally Invasive Surgery
