后腹腔CO_2气腹对肾脏功能及微结构的影响

The influence of retroperitoneal artificial pneumoperitoneum to the renal cellular structure.

目的探讨后腹腔CO2气腹对肾脏功能及肾细胞微结构的影响。方法选择需手术治疗的肾囊肿、肾肿瘤及肾上腺腺瘤患者共60例,分为经后腹腔腹腔镜手术组和开放手术组,每组30例。检测其血和尿β2-微球蛋白(β2-MG)术前基础值及手术结束时值,了解有无肾小球滤过功能、肾小管重吸收功能改变。术后行肾脏穿刺,穿刺组织行光学显微镜及电子显微镜检查,了解有无肾细胞微结构的破坏。结果开放手术组和经后腹腔腹腔镜手术组在年龄、体重指数(kg/m2)、术中静脉补液量及手术时间基本相同的情况下,开放手术组和经后腹腔腹腔镜手术组手术前后血β2-MG差值变化(t=0.023,P>0.25)及尿β2-MG差值变化(t=1.532,P>0.1),差异无统计学意义。两组光学显微镜及电子显微镜观察肾细胞微结构均未见明显破坏。结论常规气腹压力下(13～15mmHg),经后腹腔腹腔镜手术对肾脏功能及肾细胞微结构没有明显影响,该手术安全、可行。

Objective To evaluate the effect of the pneumoperitoneum perf 1 ormed in the retroperitoneal laparoscopy on the renal cellular structure.Methods 60 kidney neoplasms,adrenal adenoma and renal cyst patients who need operations were enrolled into the experiment.30 of them were assigned to retroperitoneal laparoscopic nephrectomy,the other 30 open nephrectomy.Levels of β2-microglobulin（β2-MG）in the urine and serum were measured at baseline before operation and at the time of sugery termination were recorded to evaluated the funtion of glomerular filtration function,tubular reAbsorption function.The renal tissues that obtained from kidney puncture after operation were viewed under electro-microscopic visualization to understand whether the organelle is injuryed.Results The open and retroperitoneal laparoscopic groups were similar in age,body mass index（kg/m2）,operative time,and intraoperative fluid administered.According of our experiment result,the difference of the β2-MG in the serum,there was no significance differences between two groups（t=0.023,P0.25）.The difference of the β2-MG in the urine,there was still no significance between two groups（t=1.532,P0.1）.The renal organelle in both group wasn＇t viewed injuryed under the light microscope and the electro-microscopic visualization.Conclusion Retroperitoneal route laparoscopic nephrectomy performed under the pneumoperitoneum pressure of 13～15mmHg have no effect to the renal cellular structure.Retroperitoneal route laparoscopic nephrectomy is safe and feasible.