摘要
目的后腹腔镜肾癌根治术已成为肾癌手术治疗的常规方法,但如何客观评价其微创手术效果,目前报道不一。观察后腹腔镜肾癌根治术和开放性肾癌根治术围手术期患者血清细胞因子水平的变化及临床意义,比较2种手术方式对机体细胞因子水平的影响。方法行后腹腔镜肾癌根治术67例,开放性肾癌根治术65例,对其术前24 h及术后3、24、48 h的白细胞介素(IL)-1β、IL-6、IL-10、肿瘤坏死因子(TNF)-α进行检测,并分析两者间差异是否有显著性意义,并对其手术时间、术中出血量、术后住院天数进行比较,近远期并发症进行观察。结果开放性肾癌根治手术组患者术后3、24 h血清IL-1β、IL-6水平较术前明显升高,差异有显著性意义(P<0.05),术后48 h开始恢复正常,血清IL-10、TNF-α水平手术前后变化不明显,而腹腔镜肾癌根治手术组手术前后各指标均无明显变化(P>0.05),IL-1β,IL-10水平的变化跟开放手术相比,差异有显著性意义(P<0.05)。2组在手术时间上无明显差异,但后腹腔镜肾癌根治手术组在住院天数、失血量、切口感染发生率等方面均优于开放手术组。结论开放性肾癌根治手术可造成患者血清中细胞因子IL-1β、IL-6水平升高,而后腹腔镜肾癌根治手术围手术期血清中细胞因子变化不明显,与开放手术相比,后腹腔镜肾癌根治手术对细胞因子水平影响小,术后恢复快。
] Objective Retroperitoneal laparoscopic radical nephrectomy has become a common treatment option for renal cell carcinoma(RCC),but opinions vary about its minimal invasiveness.The aim of this study was to investigate the cytokine responses and clinical significance of retroperitoneal laparoscopic and open radical nephrectomy in the treatment of RCC patients.Methods Sixty-seven RCC patients underwent retroperitoneal laparoscopic radical nephrectomy(group A) and another 65(group B) received open radical nephrectomy.Blood samples were analyzed for interleukin-1-beta(IL-1β),interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-alpha(TNF-α) at 24h before and 3,24 and 48h after the operation.Analyses were made on the operation time,blood loss,hospital stay,and short-and long-term complications.Results In group B,serum IL-1β and IL-6 concentrations were significantly elevated at 3 and 24h after the operation as compared with pre-operation(P<0.05),but gradually returned to normal within 48h.No significant changes were observed in the serum levels of IL-10 and TNF-α during the operation.Group A showed significant differences in IL-1β and IL-6 as compared with B(P<0.05),but not in IL-1β,IL-6,IL-10 and TNF-α before and after surgery(P>0.05).It also exhibited a shorter hospital stay,less blood loss and lower wound infection percentage than group B.Conclusion Open radical nephrectomy could cause the increased levels of IL-1β and IL-6,while laparoscopical surgery effects few changes in cytokines.Compared with open surgery,laparoscopical radical nephrectomy is a better alternative advantageous for its safety,minimal invasiveness and fast recovery.
出处
《医学研究生学报》
CAS
2011年第11期1173-1176,共4页
Journal of Medical Postgraduates
关键词
后腹腔镜
肾癌
细胞因子
围手术期
Retroperitoneal laparoscopy
Renal cell carcinoma
Cytokine
Perioperative period
