腹腔镜肾部分切除与肾切除对小型猪肝肾功能的影响

Effects of laparoscopic partial nephrectomy and laparoscopic radical nephrectomy on liver and renal functions in miniature pigs

本试验旨在比较腹腔镜下肾部分切除与肾切除对小型猪肝肾功能的影响,评估手术的安全性与可行性,为两种手术方法的应用提供科学依据。试验以10头广西巴马小型猪为研究对象,随机分为腹腔镜肾部分切除术组(LPN组)与腹腔镜肾切除术组(LRN组),分别于术前、术后即刻、术后1d、2d、3d、5d、7d、14d采取前腔静脉血,检测肝功能指标丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST),肾功能指标β2微球蛋白(β2-MG)、肾损伤分子-1(KIM-1)、胱抑素C(CYS-C),比较其差异性。结果显示,两组手术均成功完成,肝、肾功能指标均呈先升高后降低趋势,与试验前相比差异极显著(P<0.01)。LPN组术后肝功能指标高于LRN组,差异极显著(P<0.01);LPN组术后肾功能指标略高于LRN组,无显著性差异(P>0.05),LPN组肾功能指标恢复至术前水平更快速。结果表明,LPN较LRN在短期内会造成更严重的肝肾损伤,但更有利于肾功能恢复,临床上应依据不同情况进行选择。

This experiment was to investigatethe alternations in liver and renal functions after laparoscopic partial nephrectomy（LPN） and laparoscopic radical nephrectomy（LRN）,and provide evidence for two kinds of surgery in the clinical application and promotion.Ten bama miniature pigs were used in this study,randomly divided into two groups：LPN and LRN groups.The precava blood was respectively taken from each group at pre-operation,post-operation immediately,1 d,2 d,3 d,5 d,7 d,14 d post-operation.The indexes of liver function including alanine aminotransferase（ALT） and aspertate aminotransferase（AST） were detected; the indexes of renal function including beta 2 microglobulin（β2-MG）,kidney injury molecule 1（KIM-1） and cystatin c（CYS-C） were detected.The result showed that the indexes of liver andrenal functions of two groups were increased at first and decreased subsequently,and had extremely significant differences compared with pre-operation（P〈0.01）.The indexes of liver function post-operation in the LPN group were significantly higher than those of LRN group（P〈0.01）.The indexes of renal function post-operation in the LPN group were slightly higher than those of LRN group,but there was no significant difference（P〉0.05）.The indexes of renal function in the LPN group restored to the level of pre-operation more rapidly.The results indicated that compared with LRN,LPN resulted in more serious liver and renal damages in a short time,but was more conducive to renal function recovery.