腹腔镜手术对老年上尿路疾病患者认知功能的影响

The Impact of Laparoscopic Surgery on Cognitive Function in Patients with Urinary Tract Disease in Elderly

目的:探讨腹腔镜及开放手术对老年上尿路疾病患者认知功能的影响。方法:选取67例经腹膜后途径上尿路手术的老年患者,手术均取全麻、健侧卧位。试验组41例经腹膜后腹腔镜手术;对照组26例行开放手术。分别于术前1 d、术后第1、5天用简易智力状态检查表(MMSE)评价两组患者的认知功能。记录两组患者术中出血量、手术时间、术后苏醒时间。结果:67例均完成随访,术后第1天认知功能障碍发生了3例,试验组1例、对照组2例,发生率分别为2.4%和7.6%;术后第5天认知功能障碍发生了2例,试验组和对照组各1例,发生率分别为2.4%和3.8%;两组比较差异均有统计学意义(P<0.05)。比较两组患者术中出血量、手术时间、术后苏醒时间,差异均有统计学意义(P<0.05)。手术时间>3 h认知功能障碍仅试验组发生1例,发生率2.4%。结论:与开放手术相比,老年上尿路疾病患者行腹腔镜手术认知功能障碍发生率较低,但随着手术时间增加(>3 h),术后认知功能障碍发生率高于开放手术。

Objective： To investigate the laparoscopic and open surgery impact on cognitive function in patients with urinary tract disease in elderly. Method： Analyzed 67 cases of elderly patients with urinary tract surgery by retroperitoneal approach.All patients were done general anesthesia in lateral position in surgery.The experimental group 41 cases were treated by retroperitoneal laparoscopie surgery; the control group 26 cases underwent opened surgery.Assessed cognitive function in each group respectively in the preoperative and postoperative 1 day, 5 days with simple intelligence condition check table（MMSE）.Recorded blood loss, operative time, postoperative waking time of two groups.Result： Postoperative 1 day, occurred 3 patients of all 67 cases of postoperative cognitive dysfunction, 1 case（2.4%） in the experimental group and 2 cases（7.6%） in the control group; 5 days, occurred postoperative cognitive dysfunction in 2 cases, each group of 1 case, incidence were 2.4% and 3.8%, the difference was statistically significant（P〈0.05）.Comparison of two groups of patients with intraoperative blood loss, operation time, postoperative recovery time, the difference was statistically significant（P〈0.05）.l case of dysfunction with operation time〉3 h in experimental group, incidence was 2.4%.Conclusion： The elderly patients have a low incidence of cognitive dysfunction after laparoscopic surgery, but with the increase of operation time（〉3 h）, the incidence of postoperative cognitive dysfunction is higher than open surgery.