不同入路腹腔镜手术治疗肾癌对患者临床综合指标的影响

Comparative analysis of clinical comprehensive indexes of laparoscopic surgery for renal carcinoma via different approaches

目的 探讨不同入路腹腔镜肾癌根治术对肾癌患者临床综合指标的影响。方法 将90例肾癌患者按照随机数字表法分为研究组与对照组,各45例。研究组给予经腹膜后途径腹腔镜肾癌根治术,对照组给予经腹腔途径腹腔镜肾癌根治术。比较两组手术时间、术中出血量、术后引流量、住院时间、术后胃肠功能恢复时间。术前30 min、术后24 h比较两组患者的门静脉压、门静脉最大流速、肝总动脉流量。术前、术后第3 d、第7 d比较两组C反应蛋白、肿瘤坏死因子-α、白细胞介素-6水平。比较两组再灌注损伤、肠道细菌移位及并发症发生率。结果 两组术中出血量、术后引流量、手术时间、住院时间、术后胃肠功能恢复时间比较差异无统计学意义(P>0.05)。术后24 h两组门静脉压、门静脉最大流速较术前30 min显著降低(P<0.01),肝总动脉流量较术前30 min显著升高(P<0.01),研究组较对照组变化更显著(P<0.01)。术后第3 d两组C反应蛋白、肿瘤坏死因子-α、白细胞介素-6水平均较术前显著升高(P<0.01),研究组显著低于对照组(P<0.01),术后第7 d两组C反应蛋白、肿瘤坏死因子-α、白细胞介素-6水平与术前比较差异无统计学意义(P>0.05),两组间比较差异无统计学意义(P>0.05)。研究组再灌注损伤、肠道细菌移位发生率均显著低于对照组(P<0.05),并发症发生率显著低于对照组(P<0.01)。结论 经腹膜后途径腹腔镜肾癌根治术治疗肾癌患者效果显著,在保护患者肝脏血流动力学、减轻应激反应等方面具有明显优势,可以降低再灌注损伤发生率、肠道细菌移位率,安全性高。

Objective To investigate the effect of different approaches of laparoscopic radical nephrectomy on clinical comprehensive indexes of patients with renal cancer(RC). Methods A total of 90 RC patients were divided into the study group and the control group according to random number table method, with 45 cases in each group. The study group was given retroperitoneal laparoscopic radical nephrectomy, and the control group was given transperitoneal laparoscopic radical nephrectomy. The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay and postoperative gastrointestinal function recovery time were compared between the two groups. The portal vein pressure, the maximum velocity of portal vein and the flow of common hepatic artery were compared between the two groups 30 min before operation and 24 h after operation. The levels of C-reactive protein(CRP), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) were compared between the two groups before surgery, on the 3 rd and 7 th days after surgery. Results There were no significant differences between the two groups in intraoperative blood loss, postoperative drainage volume, operation time, hospital stay, and postoperative gastrointestinal function recovery time(P>0.05). At 24 hours after operation, the portal vein pressure and the maximum velocity of portal vein in the two groups were significantly lower than those 30 min before operation(P<0.01), and the flow of the common hepatic artery was significantly higher than that 30 min before operation (P<0.01),and the change in the study group was more significant than that in the control group(P<0.01).On the 3rd day after operation,the levels of CRP,TNF-α and IL-6 in the two groups were significantly higher than those before operation(P<0.01),and the study group was significantly lower than the control group(P<0.01).On the 7th day after operation,the levels of CRP,TNF-α and IL-6 in the two groups were not significantly different from those before operation(P>0.05),and there was no significant difference between the two groups(P>0.05).The incidence of reperfusion injury and intestinal bacterial translocation in the study group was significantly lower than that in the control group(P<0.05),and the incidence of complications was significantly lower than that in the control group(P<0.01).Conclusions Laparoscopic radical nephrectomy via retroperitoneal approach in the treatment of RC patients has a significant effect.It has obvious advantages in protecting patients’ liver hemodynamics and reducing stress response.It can reduce the incidence of reperfusion injury and intestinal bacterial translocation,and has high safety.