后腹腔镜肾癌根治术对T2期肾癌患者围术期指标、肾功能及免疫功能的影响

Effects of Retroperitoneal Laparoscopic Radical Nephrectomy on Perioperative Indexes,Renal Function and Immune Function in Patients with Stage T2 Renal Cell Carcinoma

目的分析后腹腔镜肾癌根治术(LRN)对T2期肾癌患者围术期指标、肾功能及免疫功能的影响。方法选取2014年5月—2019年5月接受手术治疗的T2期肾癌90例,根据手术方式分为ORN(开放性肾癌根治术)组41例和LRN组49例。比较2组围术期指标,术前及术后72 h肾功能指标和免疫功能指标,以及术后并发症发生情况。结果LRN组术后拔管时间、术后进食时间、术后下床活动时间、住院时间较ORN组短,出血量较ORN组少(P<0.01)。术后72 h,2组β_(2)-微球蛋白(β_(2)-MG)、血肌酐(sCr)、尿素(BUN)、IgM水平较术前显著降低,IgA、IgG水平较术前升高,且LRN组β_(2)-MG、sCr、BUN、IgM水平低于ORN组,LRN组IgA和IgG水平高于ORN组(P<0.05,P<0.01)。LRN组术后并发症总发生率低于ORN组(P<0.01)。结论LRN创伤小,可明显改善T2期肾癌患者免疫功能及肾功能,且术后恢复快、并发症少。

Objective To analyze the effects of retroperitoneal laparoscopic radical nephrectomy(LRN)on perioperative indexes,renal function and immune function in patients with stage T2 renal cell carcinoma(RCC).Methods A total of 90 patients with stage T2 RCC who had undergone surgeries between May 2014 and May 2019 were selected and divided into open radical nephrectomy group(ORN group,n=41)and LRN group(n=49)according to different therapeutic methods.Perioperative indexes,renal function indexes and immune function indexes before and after operation for 72 h,and postoperative incidence rate of complications were compared between two groups.Results Compared with those in ORN group,postoperative extubation time,time to firstly postoperative food intake,time of postoperative off-bed activity and duration of hospital stay were significantly shorter,and volume of blood loss was less in LRN group(P<0.01).After operation for 72 h,levels ofβ_(2)-microglobulin(β_(2)-MG),serum creatinine(sCr),urea(BUN)and IgM were significantly lower,while levels of IgA and IgG were significantly higher than those before operation in two groups;in LRN group,β_(2)-MG,sCr,BUN and IgM levels were significantly lower,while levels of IgA and IgG were significantly higher than those in ORN group(P<0.05,P<0.01).The total incidence rate of postoperative complications in LPN group was significantly lower than that in OPN group(P<0.01).Conclusion LRN is less invasive and may obviously improve immune function and renal function with rapidly postoperative recovery and few complications in treatment of patients with stage T2 RCC.