后腹腔镜与开放性肾癌根治术对老年患者心肺肝功能的影响

Impacts of Laparoscopic and Open Radical Nephrectomy for Cardiopulmonary and Liver Function of the Elders

目的:前瞻性分析比较腹腔镜和开放性肾癌根治手术后老年患者心肺肝功能的变化,探讨2种术式的创伤程度。方法:原发性肾癌老年患者43例,无其他肿瘤和心肺肝疾病病史,肾肿瘤分期T_1N_0M_0。开放手术组21例,腹腔镜手术组22例。肿瘤平均直径分别为(5.3±2.4)、(4.7±1.5)cm(P=0.37)。记录手术前后肝功能、心肌酶谱和血气指标等的变化,比较手术对2组患者心肺肝功能的影响。结果:2组患者手术过程顺利,与开放组术后同期比较,腹腔镜组心肌酶谱LDH和肝酶ALT、AST变化差异有统计学意义(P<0.05);腹腔镜组血气分析指标变化差异无统计学意义(P>0.05)。2组均无严重并发症发生。结论:腹腔镜手术对老年患者心肝功能影响低于开放手术,且持续时间短,提示腹腔镜肾癌根治手术对患者全身影响小、创伤程度轻。

Objective： To analyze the changes of the elders cardiopulmonary and liver function after laparoscopic and open radical nephrectorny, and to compare the surgical invasiveness of the two fashions. Methods：Patients with primary renal cell carcinoma, no history of other cancer or heart, liver and lung diseases and the tumor stage of T1N0M0, were selected. Patients who underwent open surgery （21 eases） and those who underwent laparoseopic surgery （22 cases） were included. The mean tumor size for open surgery and laparoscopic surgery was （5.3±2.4） and （4.7±1.5） cm （P=0.37） respectively. The zymograms of heart, liver and lung in two groups were recorded. and the impacts of those two surgical manners on cardiopulmonary and liver function were compared. Results： The procedures of the two groups completed smoothly. In the group of laparoscol,）ic surgery, the zymograms of heart, Iiver（LDH,AST,ALT） were all lower than those in the group of open surgery （P〈0.05）. In the group of laparoscopic surgery, the changes of the blood gas analysis were no of significant difference（P〉0.05）. No severe complication occurred in both groups. Conclusions： As compared to open nephrectomy, the laparoscopic radical nephrectomy has less impact on cardiopulmonary and liver function. It is indicated thal the laparoscopic surgery is a less invasive procedure for radical nephrectomy.