腹腔镜治疗肾癌合并下腔静脉癌栓的临床研究

A clinical study on laparoscopic surgery in the treatment of patients with renal carcinoma combined with inferior vena cava tumor thrombosis

目的探讨腹腔镜治疗肾癌(Renal carcinoma,RC)合并下腔静脉癌栓(Inferior vena cava tumor thrombus,IVCTT)(下称RC-IVCTT)的临床疗效。方法 2011年1月至2016年12月我院RC-IVCTT患者80例,依据随机数字表法分为实验组和开放组各40例,实验组行腹腔镜治疗,开放组行开放治疗。观察两组术中出血量、术中输血量、手术时间、术后住院时间,术前、术后7d外周血基质金属蛋白酶-9(MMP-9)、血小板衍生生长因子(PDGF-BB)、血管内皮生长因子(VEGF)及炎性因子,术前、术后12 h外周血致痛因子及术后并发症。结果实验组术中出血量、术中输血量、手术时间、术后住院时间均少于对照组(P<0.05)。术后7d,两组MMP-9、PDGF-BB、VEGF差异无统计学意义(P>0.05),实验组CRP、IL-6、IL-8低于开腹组(P<0.05)。术后24 h,实验组NPY、PGE2、BK、5-HT低于开胸组(P<0.05)。实验组术后并发症发生率低于开放组(P<0.05)。结论腹腔镜治疗RC-IVCTT创伤小,疼痛轻,恢复快,疗效好,术后并发症少。

To investigate the clinical efficacy of laparoscopic surgery in the treatment of patients with renal carcinoma(RC)combined with inferior vena cava tumor thrombosis(IVCTT).A total of 80 patients with RC-IVCTT admitted to our hospital from January 2011 to December 2016 were selected.The patients were divided into experimental group(n=40)and open group(n=40)according to random number table method.Patients in the experimental group underwent laparoscopic treatment,while those in open group underwent open treatment.The intraoperative blood loss,intraoperative blood transfusion volume,operation time,postoperative hospitalization time,levels of matrix metalloproteinases-9(MMP-9),platelet-derived growth factor(PDGF-BB),vascular endothelial growth factor(VEGF)and inflammatory factors in peripheral blood before operation and 7d after operation,level of pain induced factors in peripheral blood before operation and 12 h after operation and postoperative complications were compared between the two groups.The intraoperative blood loss,intraoperative blood transfusion volume,operation time and postoperative hospitalization time in the experimental group were lower or shorter than those in the open group(P<0.05).There was no difference in levels of MMP-9,PDGF-BB and VEGF between the two groups after 7d of operation(P>0.05).The levels of CRP,IL-6 and IL-8 in the experimental group on the 7d after operation were lower than those in the open group(P<0.05).The levels of NPY,PGE2,BK and 5-HT in the experimental group at 24 h after operation were lower than those in the open group(P<0.05).The incidence of postoperative complications in the experimental group was lower than that in open group(P<0.05).Laparoscopic surgery in the treatment of patients with RC-IVCTT has small trauma,less pain,fast recovery,favorable curative effect and less postoperative complications.Laparoscopy