后腹腔镜肾上腺切除术围术期采用加速康复外科处理方案对炎症反应影响的研究

Inflammatory response of fast track surgery strategy for patients undergoing retroperitoneal laparoscopic adrenalectomy

目的比较行后腹腔镜肾上腺切除术患者围术期应用加速康复外科处理方案与常规处理方案对患者炎症反应的影响。方法将80例行后腹腔镜肾上腺切除术的患者随机分为FTS组和对照组,FTS组给予加速康复外科处理,对照组给予常规围术期处理。记录并比较2组术前24 h,术后2、24 h的IL-1β、IL-6、IL-10、TNF-α、CRP、白细胞计数等指标,同时观察并比较2组手术时间、术中出血量、导尿管和引流管留置时间、住院时间等方面的变化。结果 FTS组术后2、24 h的CRP、TNF-α、IL-1β、IL-6、IL-10水平明显低于对照组(P<0.01);白细胞计数方面,2组术后24 h差异有统计学意义(P<0.05);FTS组导尿管和引流管留置时间、术后住院时间较对照组明显减少(P<0.01)。结论后腹腔镜肾上腺切除术围术期采用加速康复外科处理方案能减轻患者的炎症反应,有利于患者的术后康复。

Objective To compare the impact of fast track surgery（FTS） vs conventional care on inflammatory response after retroperitoneal laparoscopic adrenalectomy.Methods Eighty patients were randomly assigned to fast tract groups and conventional groups（40 cases in each group）.These patients undergoing retroperitoneal laparoscopic adrenalectomy received either conventional care or an FTS recovery program.Blood samples were analyzed for interleukin-1-beta（IL-1β）,interleukin-6（IL-6）,interleukin-10（IL-10）,tumor necrosis factor-alpha（TNF-α）,C-Reactive protein（CRP）,white blood cell count at 24h before and 2,24 h after the operation.In addition,operation time,blood loss,time of drain and transurethral catheterization usage,time of mobilization,hospital discharge times after surgery were compared between the two groups.Results CRP,TNF-α,IL-1β,IL-6,and IL-10 concentrations at 2 and 24 h after the operation were lower compared with the control group.White blood cell count differed significantly at 24 h after surgery（P0.05）.As compared with the control group,time of drain and transurethral catheterization usage,length of hospital stay were markedly shortened in the study group（P0.01）.Conclusion Compared with conventional care,fast tract surgery within retroperitoneal laparoscopic adrenalectomy can reduce inflammatory response and fast recovery.