摘要
目的比较后腹腔镜与传统开放式肾切除术对机体应激反应的影响。方法选取泌尿外科2010年10月—2012年1月期间行后腹腔镜及开放性肾切除的患者34例,其中行后腹腔镜手术患者23例,开放手术者11例。分别于术前1 d及术后1 d、3 d记录患者的白细胞计数、血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)等指标,并记录手术时间、术中出血量以及术后的引流量、术后发热持续时间、肠蠕动恢复时间等应激反应指标,并比较2组内及组间的变化。结果 2组患者手术时间和术后发热时间、引流量、白细胞计数相比差异无统计学意义(P>0.05),而术中出血量、肠蠕动恢复时间、CRP、IL-6水平后腹腔镜组明显低于开放手术组(P<0.01,P<0.05)。组内比较,术后1 d、3 d白细胞计数、CRP、IL-6水平均较术前增高(P<0.01,P<0.05),术后第1天达到高峰,以后开始下降。且随着手术熟练,后腹腔镜组手术时间明显缩短,术中出血量明显减少。结论后腹腔镜肾切除术对机体应激反应的影响显著小于开放手术,且随着术者操作熟练度的增加,后腹腔镜手术的优势越大,目前正逐步取代传统开放式肾切除术。
Objective To compare the influence of retroperitoneal laparoscopic nephrectomy and open nephrectomy on the systemic stress responses. Methods Twenty-three patients with retroperitoneal laparoscopic nephrectomy and 11 patients with open nephrectomy in our hospital from October 2010 to January 2012 were selected. The white blood cell （WBC） counts, serum C-reactive protein （CRP） level, interleukin-6 （ IL-6 ） level, operation duration, intraoperative blood losing, post-operative drainage, post-operative fever time and recovery time of intestinal peristalsis were recorded on the day before the operation,dl and d3 after the operation, and the difference between the two groups were compared. Results There was no difference in the operation duration, post-operative fever time, drainage mad white blood cell counts between the two groups（ P 〉 0.05 ）. The level of intraoperative blood losing, recovery time of intestinal peristalsis, CRP and IL-6 levels in the retroperitoneal laparoscopic nephrectomy group were obviously lower than those in the open nephrectomy group（ P 〈 0.01 ,P 〈 0.05 ）. The level of white blood cell counts, CRP and IL-6 levels on dl and d3 after the operation in both groups were higher than those before the operation （P 〈 0.01, P 〈 0.05 ）, achieved the peak value on the d l after the operation and then descended. With the improvement of operation skills, the duration for retroperitoneal laparoscopic nephreetomy will be greatly shortened,resuhing in significant reduction in intraoperative blood loss. Conclusion The influence of retroperitoneal laparoscopic nephrectomy on systemic stress responses is distinctly lower than open nephreetomy; with the improvement of surgical skills, the retroperitoneal laparoscopic nephrectomy will have greater benefits which enable such kind of surgery to replace open nephrectomy in a step-by-step manner.
出处
《中华全科医学》
2015年第10期1591-1593,1610,共4页
Chinese Journal of General Practice
基金
安徽省蚌埠医学院学院课题(BY1047)
