CAJ | 학술논문

目的观察后腹腔镜手术对局限性肾癌患者免疫功能及神经内分泌功能的影响,评价后腹腔镜手术的临床疗效.方法分析2010年1月至2013年1月我科采用后腹腔镜根治性肾切除术(LRN组,36例)及开放性根治性肾切除术(ORN组,27例)治疗肾癌患者的临床资料.经术前B超、CT、MRI和术后病理诊断为肾细胞癌,临床分期均为T1～T2N0M0.肿瘤直径约2.2～9.8cm,平均5.6cm,单发.评估两种术式的手术时间、术中出血量、术后住院时间,并检测患者手术前后血液的免疫指标(CD3+、CD4+、CD8+、CD4 +/CD8+)和神经内分泌指标[β-内啡肽、促肾上腺皮质激素(ACTH)、皮质醇].结果所有手术均顺利完成,围术期未出现严重并发症.LRN、ORN组的术中出血量分别为(95.0±29.5)和(112.8±31.3)ml(P＜0.05);术后住院时间分别为(7.1±1.3)和(8.7±1.7)d(P＜0.05).两组手术时间差异无统计学意义(P＞0.05).LRN组术后CD3+、CD4+及CD4+/CD8+明显高于ORN组(P＜0.05);且LRN组术后β-内啡肽、ACTH及皮质醇水平明显低于ORN组,差异有统计学意义(P＜0.05).随访3～33个月,平均14个月,2例失访,随访患者无远期并发症,影像学检查未见肿瘤复发或转移.结论后腹腔镜根治性肾切除术具有视野清晰、创伤小、术中出血少、术后恢复快、住院时间短等优点,且腹腔镜手术治疗局限性肾癌比开放性手术更有保护免疫功能和减轻应激反应的优势.
목적 관찰후복강경수술대국한성신암환자면역공능급신경내분비공능적영향,평개후복강경수술적림상료효.방법 분석2010년1월지2013년1월아과채용후복강경근치성신절제술(LRN조,36례)급개방성근치성신절제술(ORN조,27례)치료신암환자적림상자료.경술전B초、CT、MRI화술후병리진단위신세포암,림상분기균위T1～T2N0M0.종류직경약2.2～9.8cm,평균5.6cm,단발.평고량충술식적수술시간、술중출혈량、술후주원시간,병검측환자수술전후혈액적면역지표(CD3+、CD4+、CD8+、CD4 +/CD8+)화신경내분비지표[β-내배태、촉신상선피질격소(ACTH)、피질순].결과 소유수술균순리완성,위술기미출현엄중병발증.LRN、ORN조적술중출혈량분별위(95.0±29.5)화(112.8±31.3)ml(P＜0.05);술후주원시간분별위(7.1±1.3)화(8.7±1.7)d(P＜0.05).량조수술시간차이무통계학의의(P＞0.05).LRN조술후CD3+、CD4+급CD4+/CD8+명현고우ORN조(P＜0.05);차LRN조술후β-내배태、ACTH급피질순수평명현저우ORN조,차이유통계학의의(P＜0.05).수방3～33개월,평균14개월,2례실방,수방환자무원기병발증,영상학검사미견종류복발혹전이.결론 후복강경근치성신절제술구유시야청석、창상소、술중출혈소、술후회복쾌、주원시간단등우점,차복강경수술치료국한성신암비개방성수술경유보호면역공능화감경응격반응적우세.
Objective To explore the effect of retroperitoneal laparoscopic operation on immune function and neuroendocrine function in patients with renal cell carcinoma,and to evaluate clinical efficacy of retroperitoneal laparoscopic operation in treatment of renal cell carcinoma.Methods The clinical data of 36 patients subject to laparoscopic radical nephrectomy (LRN) and 27 patients with open radical nephrectomy (ORN) for renal cell carcinoma in our department from January 2010 to January 2013 were analyzed retrospectively.The renal cell carcinoma was diagnosed by preoperative ultra-sound,CT or MRI,and postoperative pathological examination.The clinical stage was T1-T2,and N0M0 in all patients.The diameter of tumors ranged 2.3-9.8 cm (5.6 cm on average),and tumor was solitary.The efficacy was evaluated by the duration of operative time,blood loss during operation and postoperative hospital stay between two groups.The changes of immune function (CD3+,CD4+,CD8+,CD4+/CD8+) and neuroendocrine function [β-endorphin,Adrenocorticotrophin (ACTH),cortisol] in patients with renal cell carcinoma before and after surgical operation were examined.Results The 63 patients were operated successfully,and there were no severe perioperative complications.Blood loss during operation was (95.0 ± 29.5) ml in LRN group and (112.8 ±31.3) ml in ORN group (P ＜0.05).The mean postoperative hospital stay was (7.1 ± 1.3) days in LRN group and (8.7 ± 1.7) days in ORN group (P＜0.05).No significant difference in operative time was noted between two groups (P ＞ 0.05).After surgical operation,the proportion of CD3 +,CD4+ and CD4 +/CD8 + in LRN group was significantly higher than in ORN group (P ＜0.05),and the levels of β-endorphin,ACTH and cortisol in LRN group were significantly lower than those in control group (P ＜0.05).Average postoperative follow-up duration was 14 months (range 3-33) in 61 patients.Imaging examinations showed no recurrence or metastasis in all patients,and no patients had longterm complication.Conclusion Retroperitoneal laparoscopic operation has advantages of clearer vision,less trauma,less blood loss,faster postoperative recovery,and shorter hospital stay.In the treatment of localized renal cell carcinoma,LRN has more advantages than ORN because LRN can protect immune function better and reduce stress response better.