摘要
目的探究后腹腔镜根治性肾切除术(RLRN)与开放性肾部分切除术(OPN)治疗对肾肿瘤患者血清皮质醇、尿激酶型纤溶酶原激活物(u PA)、血管内皮生长因子(VEGF)、胰岛素样生长因子-1(IGF-1)水平的影响。方法将本医院肿瘤科2014年7月～2017年10月期间收治的120例肾肿瘤患者根据手术方法不同分为RLRN组80例、OPN组40例,记录所有患者手术进行情况,术前术后采集患者静脉血标本进行血清皮质醇、u PA、VEGF和IGF-1检测。结果与OPN组相比,RLRN组手术时间与之接近,差异不明显(P>0. 05),但出血量明显少,术后肛门排气时间、置管时间及住院时间明显缩短,差异有统计学意义(P<0. 05)。RLRN组切口感染、皮下气肿、肺部感染发生率依次为2. 50%、3. 75%、1. 25%,明显低于OPN组的15. 00%、17. 50%、10. 00%,差异有统计学意义(P <0. 05)。两组术前血清皮质醇、u PA、VEGF和IGF-1水平差异不明显(P>0. 05),术后24h血清皮质醇明显升高,u PA、VEGF、IGF-1明显下降,但RLRN组皮质醇升高幅度明显较OPN组小,u PA、VEGF、IGF-1降低幅度明显较OPN组大,差异有统计学意义(P<0. 05)。结论与OPN相比,RL-RN治疗肾肿瘤患者除了术后恢复快及安全性高以外,还有助于改善患者术后血清皮质醇、u PA、VEGF和IGF-1水平。
Objective To explore the effects of retroperitoneal laparoscopic radical nephrectomy(RLRN)and open partial nephrectomy(OPN)on levels of serum cortisol,urokinase type plasminogen activator(uPA),vascular endothelial growth factor(VEGF)and insulin-like growth factor -1(IGF-1)in patients with renal tumors.Methods 120 cases with renal tumors undergoing operation in different surgical ways during the period from July,2014 to Oct.,2017 were selected and divided into 2 groups:RLRN group(n=80)and OPN group(n=40);operation data were recorded and detection of serum cortisol,uPA,VEGF and IGF-1 were applied to all the cases before and after operation.Results The operation time in RLRN group was of no obvious difference from that in OPN group(P>0.05)while the bleeding volume in operation,the time of postoperative anal exhaust,catheter indwelling and hospitalization in RLRN group were smaller and shorter than those in OPN group(P<0.05);the incidence of incision infection,subcutaneous emphysema and pulmonary infection in RLRN group were 2.50%,3.75% and 1.25% respectively,much lower than those in OPN group(15.00%,17.50%,10.00%)(P<0.05);before operation,no obvious differences existed in the levels of serum cortisol,uPA,VEGF and IGF-1 between the 2 groups(P>0.05);24 hours after operation,the level of serum cortisol in the 2 groups increased obviously and the levels of uPA,VEGF and IGF-1 decreased significantly,and a smaller increase in serum cortisol and a bigger decrease in uPA,VEGF and IGF-1 were found in RLRN group when compared with those in OPN group(P<0.05).Conclusions RLRN can promote a faster post-operative recovery with a higher safety that OPN and is of a greater help in improving the serum levels of cortisol,uPA,VEGF and IGF-1 of patients with renal tumors.
作者
徐小涵
唐贤富
Xu Xiaohan;Tang Xianfu(Department of Urinary Surgery,West China-Guang an Hospital,Sichuan University,Guang'an City,Sichuan Province,638000,P.R.China)
出处
《西南军医》
2019年第1期19-22,共4页
Journal of Military Surgeon in Southwest China
关键词
后腹腔镜根治性肾切除术
开放性肾部分切除术
肾肿瘤
实验室指标
retroperitoneal laparoscopic radical nephrectomy (RLRN)
open partial nephrectomy (OPN)
renal tumor
lab index
