腹腔镜与开腹胆囊切除术对患者急性创伤性氧化应激反应、能量代谢及肾功能的对比研究

Comparison of impacts between laparoscopic and open surgery on acute traumatic oxidative stress reaction, metabolism and renal function in patients with benign gallbladder diseases

目的探讨腹腔镜与开腹胆囊切除术对患者急性创伤性氧化应激反应、能量代谢及肾功能的影响。方法将80例胆囊良性疾病患者按照手术方式随机分为腹腔镜胆囊切除术组（观察组,n=40例）和开腹胆囊切除术组（对照组,n=40例）,检测两组患者术前及术后1、3、5天的血浆丙二醛含量（MDA）、超氧化物歧化酶水平（SOD）、8-异前列腺素F2α（8-iso-PGF2α）及C反应蛋白（CRP）水平;静态能量消耗（REE）与呼吸商（RQ）值;以及血肌酐（Scr）及血尿素氮（BUN）,同时在相同时间点留取尿标本测定微量白蛋白（Alb）及N-乙酰-β-D-氨基葡萄糖苷酶（NAG）含量。结果与术前前比较,两组患者MDA、8-iso-PGF2α、CRP均在术后1天升高达到高峰后降低,而SOD则呈相反趋势,观察组术后1-5天的MDA、8-iso-PGF2α、CRP水平低于对照组（P〈0.05）,而SOD则高于对照组（P〈0.05）;两组REE亦在术后1天升高达到高峰后降低,而RQ则呈相反趋势,观察组治疗后1-5天的REE低于对照组（P〈0.05）,而RQ则高于对照组（P〈0.05）;两组Scr及BUN围术期并未出现明显的统计学变化（P〉0.05）,两组尿Alb/Cr和NAG/Cr在术后1天明显增高,之后逐渐回落,观察组尿Alb/Cr和NAG/Cr在术后1天高于对照组（P〈0.05）,但在术后3-5天恢复至术前水平。结论腹腔镜手术对患者术后肾功能造成一过性损伤,但不影响患者恢复,但腹腔镜手术创伤小,造成的创伤性氧化应激及炎性损伤程度较轻,且消耗机体能量少,有利于患者的恢复。

Objective To discussed and compared the impacts between laparoscopic and open surgery on acute traumatic oxidative stress reaction,metabolism and renal function in patients with benign gallbladder disease. Methods 80 patients with gallbladder benign disease according to the operation method were randomly divided into of laparoscopic cholecystectomy group（observation group, n=40 cases） and open cholecystectomy group（the control group, n=40）, malondialdehyde（MDA）, superoxide dismutase（SOD）, 8-iso-PGF2α and C-reactive protein（CRP） levels were detected before surgery and postoperative 1d, 3d, 5d. The value of resting energy expenditure（REE） and respiratory quotient（RQ） were also measured. And serum creatinine（Scr） and blood urea nitrogen（BUN）, albumin（Alb） and N-acetyl-beta-D-amino glycosidase enzymes（NAG） in the urine were detected at the same point. Results Compared with before surgery, MDA, 8-iso-PGF2α and CRP of two groups were higher, reached the peak on postoperative 1d and then decreased, while SOD showed the opposite trend, MDA, 8-iso-PGF2α and CRP of observation group were lower than those of control group on postoperative 1-5 d（P〈0.05）.While SOD was higher than control group（P〈0.05）. REE of two groups were higher, reached the peak on postoperative 1d and then decreased, while RQ showed the opposite trend. REE of observation group were lower than those of control group on postoperative 1-5 d（P〈0.05）. While RQ was higher than control group（P〈0.05）. Scr and BUN had no obvious statistical changes after surgery（P〉0.05）. Urine Alb/Cr and NAG/Cr of two groups were higher than before surgery, then gradually retreated, urine Alb/Cr and NAG/Cr of observation group were higher than control group on postoperative 1d（P〈0.05）, but recovered to preoperative level after 3-5d. Conclusion Laparoscopic surgery can result in transient damage of renal function, but does not affect the patients recover,however, the method the advantages of small trauma, less degree of traumatic oxidative stress and inflammatory damage and low energy consumption, and is helpful to the recovery of patients.