目的 了解腹腔镜手术对肝功能变化的影响以及探讨其可能的发生机制。方法 286例腹镜胆囊切除术（LC）患者被随机分为a，b 2组，在术前及手术后第1、2、7天接受肝功能检测。把40例开腹胆囊切除术（OC）患者的手术前、后肝功能与LC进行对照。另外，18例腹腔镜结、直肠癌手术（LCR）患者与23例开腹结、直肠癌（OCR）手术的患者也参与了研究。结果LC与LCR患者的血清谷丙转氨酶（ALT）与谷草转氨酶（AST）与术前比较，都有显著性差异（P<0.05）。LC与OC、LCR与OCR相比，ALT术后24h与48h均有显著性差异（P<0.05）。同样，LC与OC、LCR与OCR相比，AST术后24h与48h也均有显著性差异（P<0.05）。同时也对其他的肝功能指标进行了检测与数据处理，未发现有意义的改变。结论 腹腔镜手术可导致血清肝转移酶有统计学意义的短暂性增高。CO2气腹是造成血清肝转移酶变化的主要原因。这种血清肝脏酶学的短暂性改变对大多数接受腹腔镜手术的患者不会造成不良影响，无临床意义。

AIM: The purpose of this study was to investigate the effect of laparoscopic surgery on liver function in humans and the possible mechanisms behind such effect. METHODS: Blood samples from 286 patients who underwent laparoscopic cholecystectomy (LC) and 40 patients who underwent open cholecystectomy (OC) were tested for liver function by measuring the level of serum alanine aminotrasferase (ALT) and aspartate aminotrasferase (AST) before and after the operations. The same tests were also applied to 18 laparoscopic colorectal cancer resection (LCR) patients and 23 open colorectal cancer resection (OCR) patients to determine whether CO2 pneumoperitoneum could alter the serum liver enzymes. RESULTS: The level of serum ALT and AST increased significantly during the first 48 hours post operations in both LC and LCR patients. However, no significant change of the serum liver enzymes was detected in both OC and OCR patients. As a result, there was statistically significant difference in change of both ALT and AST levels between LC and OC patients and LCR and OCR patients, respectively. By the 7th day post operation, the level of both enzymes returned to normal values in LC, OC and OCR patients except LCR patients whose enzymes remained at a higher level. CONCLUSION: Transient elevation of hepatic transaminases occurred after laparoscopic surgery. The major causative factor seemed to be the CO2 pneumoperitoneum. In most of the laparoscopic surgery patients, the transient elevation of serum liver enzymes showed no apparent clinical implications. However, if preoperative liver function was very poor, laparoscopic surgery may not be the best choice for the treatment of patients with certain abdominal diseases.

AIM: To introduce our latest innovation on technical manipulation of laparoscopic splenectomy. METHODS: Under general anesthesia and carbon dioxide (CO2) pneumoperitoneum, 86 cases of laparoscopic splenectomy (LS) were performed. The patients were placed in three different operative positions: 7 cases in the lithotomic position, 31 cases in the right recumbent position and 48 cases in the right lateral position. An ultrasonic scissors was used to dissect the pancreaticosplenic ligament, the splenocolicum ligament, lienorenal ligament and the lienophrenic ligament, respectively. Lastly, the gastrosplenic ligament and short gastric vessels were dissected. The splenic artery and vein were resected at splenic hilum with Endo-GIA. The impact of different operative positions, spleen size and other events during the operation were studied. RESULTS: The laparoscopic splenectomy was successfully performed on all 86 patients from August 1997 to August 2002. No operative complications, such as peritoneal cavity infection, massive bleeding after operation and adjacent organs injured were observed. There was no death related to the operation. The study showed that different operative positions could significantly influence the manipulation of LS. The right lateral position had more advantages than the lithotomic position and the right recumbent position in LS. CONCLUSION: Most cases of LS could be accomplished successfully when patients are placed in the right lateral position. The right lateral position has more advantages than the conventional supine approach by providing a more direct view of the splenic hilum as well as other important anatomies. Regardless of operation positions, the major axis of spleen exceeding 15 cm by B-ultrasound in vitro will surely increase the difficulties of LS and therefore prolong the duration of operation. LS is a safe and feasible modality for splenectomy.

目的：探讨腹腔镜下行大肠癌手术的要点与并发症的防治。方法：对应用腹腔镜技术进行手术的82例大肠癌患者的临床资料进行总结性分析。结果及结论：全组病人均采用腹腔镜完成手术，术中及术后未发生重走并发症。术后无因并发症而死亡的病倒。除1例术后11个月发生肿瘤肝转移须行手术切除和1例穿刺孔及辅助切口肿瘤种植复发外，其他病人未见肿瘤的复发厦转移。只要掌握好腹腔镜的操作技巧及大肠癌切除的手术指征，重视关键部位的操作，用腹腔镜治疗大肠癌是可行的，其并发症会随着操作技巧的提高而降低。