腹腔镜肾囊肿去顶术对肾囊肿患者临床疗效及应激反应变化研究

Clinical efficiency and stress response changes of laparoscopic renal cyst unroofing in treatment with renal cyst patients

目的探讨腹腔镜肾囊肿去顶术对肾囊肿患者临床疗效及患者应激反应的影响。方法选择2011年7月至2014年7月,武汉市第六医院收治的90例肾囊肿患者为研究对象。采用随机数字表法将患者分成腹腔镜组和穿刺组,每组各45例。腹腔镜组采用腹腔镜肾囊肿去顶术,穿刺组行B超引导下囊肿穿刺硬化术。记录两组患者手术时间、术中出血量、住院时间及术后并发症、复发率等情况。分别于术前、术毕时、术后1 d、术后3 d检测两组患者血糖及血清白细胞介素-6（IL-6）、C-反应蛋白（CRP）、皮质醇（Cor）水平。结果两组患者均顺利完成手术,术后B超检查显示囊肿消失,治愈率100%。腹腔镜组手术时间、住院时间显著长于穿刺组（P〈0.05）。腹腔镜组术后复发率为2.2%,穿刺组术后复发率15.6%,穿刺组术后复发率显著高于腹腔镜组（χ~2=4.939,P〈0.05）。两组患者术后主要并发症有血尿、肾周水肿、神经损伤、腹膜炎、局部感染等,两组患者各并发症发生率比较,差异无统计学意义（P〉0.05）。术后两组患者IL-6、CRP、Cor、血糖水平均逐渐升高,至术后1 d达高峰,此后逐渐降低,至术后3 d,患者IL-6、CRP、Cor、血糖水平依然显著高于术前（P〈0.05）,两组间手术前后各时段IL-6、CRP、Cor、血糖水平比较,差异无统计学意义（P〉0.05）。结论腹腔镜肾囊肿去顶术手术时间和住院时间较长,但复发率偏低;囊肿穿刺硬化术操作简单,耗时少,患者术后恢复更快,但复发率偏高。临床上需要针对患者的实际情况选择合适的术式。

Objective To explore the clinical efficiency and stress response changes of aparoscopic renal cyst unroofing in treatment with renal cyst patients. Methods A retrospective study was performed on 90 cases of renal cyst patients received in the Sixth Hospital of Wuhan from July 2011 to July 2014. All the patients were randomly divided into the laparoscopic group and the puncture group,with 45 cases in each group. The patients in the laparoscopic group underwent aparoscopic renal cyst unroofing and patients in the puncture group underwent ultrasound guided percutaneous puncture sclerosis. Clinical data such as the operation time,blood loss,length of stay,postoperative complications and recurrence rate of the two groups were recorded. The blood glucose,serum interleukin 6（ IL 6）,C-reactive protein（ CRP） and cortisol（ Cor） were detected in patients of the two groups before and 1 day,3 days after the operation. Results Two groups of patients were successfully completed surgery,postoperative ultrasonography showed that the cyst disappeared and the cure rate was 100%. In the laparoscopic group,the operation time and hospitalization time were longer than those in the puncture group（ P〈0. 05）,postoperative recurrence rate in the puncture group（ 15. 6%） was significantly higher than that of laparoscopic group（ 2. 2%,χ2= 4. 939,P〈0. 05）. The main complications of the two groups were hematuria,edema,nerve injury,peritonitis and local infection,there was no significant difference in the incidence of complications between the two groups（ P〉0. 05）. After operation,IL-6,CRP,Cor and blood glucose levels of the two groups were increased gradually until reached a peak at postoperative 1day and then reduced gradually until 3 days later,which were still significantly higher than those before the operation（ P〈0. 05）.There was no significant difference in IL-6,CRP,Cor and blood glucose of the two groups before and after the surgery（ P〉0. 05）.Conclusion Laparoscopic renal cyst unroofing surgery time and duration of hospital stay are longer,on the contrary,the recurrence rate is low,cyst sclerotherapy is simple with less time-consuming and faster postoperative recovery,on the contrary,the rate of relapse is high. Therefore,the appropriate surgical method should be chosen according to the actual situation of patients.