腹腔镜下经腹入路与后腹腔入路肾部分切除术治疗单侧多发肾肿瘤的疗效及对免疫功能的影响
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摘要
目的观察腹腔镜下经腹入路与后腹腔入路肾部分切除术治疗单侧多发肾肿瘤患者的疗效及对机体免疫功能的影响。方法回顾性分析2012年1月至2018年3月粤北人民医院接收的单侧多发肾肿瘤患者68例的临床资料,均接受肾部分切除术治疗,根据腹腔镜入路方式分为经腹入路组(35例)和后腹腔入路组(33例)。记录两组手术效果、肿瘤组织病理特征、术后并发症情况,并比较两组术前及术后24 h免疫学指标。结果后腹腔入路组手术时间、术后恢复进食时间及术后住院时间均显著短于经腹入路组(P <0. 01)。术后两组肿瘤组织切缘均无阳性,两组G分级及切缘阳性情况比较差异无统计学意义(P> 0. 05);两组肿瘤组织的T分级比较,后腹腔入路组优于经腹入路组(P <0. 05)。两组术后并发症发生率比较差异无统计学意义(P> 0. 05)。术后24 h,两组白细胞计数(WBC)、C反应蛋白(CRP)及CD8+水平较术前显著升高(P <0. 01),且经腹入路组WBC、CRP水平显著高于后腹腔入路组(P <0. 01);两组CD3+、CD4+水平及CD4+/CD8+比值较术前显著降低(P <0. 01),且经腹入路组显著低于后腹腔入路组(P <0. 01)。结论经腹入路与后腹腔入路两种腹腔镜下肾部分切除术治疗单侧多发肾肿瘤均安全有效,其中经腹入路手术空间更大,后腹腔入路手术时间短、术后恢复快,能更好保护患者免疫功能。
Objective To observe the curative effects of transabdominal and retroperitoneal approaches laparoscopic partial nephrectomy in the treatment of patients with unilateral multiple renal tumors and their impacts on patients' immune function. Methods From January 2012 to March 2018,68 patients with unilateral multiple renal tumors treated in Yue Bei People's Hospital were selected as the study subjects. All patients underwent partial nephrectomy and were divided into transabdominal approach group( n = 35) and retroperitoneal approach group( n = 33) according to laparoscopic approach.The operative effect,histopathological features and postoperative complications were observed,and the preoperative and postoperative 24 h immunological indexes were compared between two groups. Results The operation time,postoperative feeding time and postoperative hospitalization time in retroperitoneal approach group were significantly shorter than those in abdominal approach group( all P < 0. 01). After surgery,there were no positive expressions in surgical margins of tumor in both groups,and there were no significant differences in G grade and positive edge incision of tumor between two groups( P> 0. 05). T-stage grades of tumor in retroperitoneal approach group were significantly better than those in transabdominal approach group( P < 0. 05). There was no significant difference in the incidence of postoperative complications between two groups( P > 0. 05). At 24 hours after operation,the levels of white blood corpuscles( WBC),C-reactive protein( CRP) and CD8+increased significantly compared with those before operation in both groups( P < 0. 01) and WBC、CRP were in transabdominal approach group significantly higher than those in retroperitoneal approach group( P < 0. 01); CD3+,CD4+levels and CD4+/CD8+ratio were significantly lower than those before operation in both groups( P < 0. 01) and were significantly lower in transabdominal approach group than those in retroperitoneal approach group( P < 0. 01). Conclusions Both transabdominal and retroperitoneal laparoscopic partial nephrectomy are safe and effective in the treatment of unilateral multiple renal tumors. The transabdominal approach has more space for operation,and the retroperitoneal approach possess shorter operation time and faster recovery,which can better protect the immune function of patients.
Objective To observe the curative effects of transabdominal and retroperitoneal approaches laparoscopic partial nephrectomy in the treatment of patients with unilateral multiple renal tumors and their impacts on patients' immune function. Methods From January 2012 to March 2018,68 patients with unilateral multiple renal tumors treated in Yue Bei People's Hospital were selected as the study subjects. All patients underwent partial nephrectomy and were divided into transabdominal approach group( n = 35) and retroperitoneal approach group( n = 33) according to laparoscopic approach.The operative effect,histopathological features and postoperative complications were observed,and the preoperative and postoperative 24 h immunological indexes were compared between two groups. Results The operation time,postoperative feeding time and postoperative hospitalization time in retroperitoneal approach group were significantly shorter than those in abdominal approach group( all P < 0. 01). After surgery,there were no positive expressions in surgical margins of tumor in both groups,and there were no significant differences in G grade and positive edge incision of tumor between two groups( P> 0. 05). T-stage grades of tumor in retroperitoneal approach group were significantly better than those in transabdominal approach group( P < 0. 05). There was no significant difference in the incidence of postoperative complications between two groups( P > 0. 05). At 24 hours after operation,the levels of white blood corpuscles( WBC),C-reactive protein( CRP) and CD8+increased significantly compared with those before operation in both groups( P < 0. 01) and WBC、CRP were in transabdominal approach group significantly higher than those in retroperitoneal approach group( P < 0. 01); CD3+,CD4+levels and CD4+/CD8+ratio were significantly lower than those before operation in both groups( P < 0. 01) and were significantly lower in transabdominal approach group than those in retroperitoneal approach group( P < 0. 01). Conclusions Both transabdominal and retroperitoneal laparoscopic partial nephrectomy are safe and effective in the treatment of unilateral multiple renal tumors. The transabdominal approach has more space for operation,and the retroperitoneal approach possess shorter operation time and faster recovery,which can better protect the immune function of patients.
引文
[1]陈健文,黄庆波,张旭,等.机器人辅助腹腔镜技术治疗单侧多发肾肿瘤的诊疗分析[J].微创泌尿外科杂志,2017,6(1):28.
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[8]周建军,李学明,曹国灿,等.经腹入路腹腔镜肾盂成形术治疗儿童肾盂输尿管连接部梗阻[J].临床小儿外科杂志,2014,13(6):506-509.
[9]王庆杰,刘贵中,孙光,等.后腹腔镜肾部分切除术治疗T1b期肾癌17例报告[J].天津医药,2014,42(1):88-89.
[10]马鑫,郑涛,史涛坪,等.肾血管低温灌注下后腹腔镜肾部分切除术处理2例复杂左侧肾肿瘤[J].微创泌尿外科杂志,2013,2(3):222-224.
[11]蒲小勇,徐战平,刘久敏,等.两种入路腹腔镜下肾部分切除术治疗R. E. N. A. L.评分≥7的肾肿瘤的比较研究[J].南方医科大学学报,2014,34(12):1818-1821.
[12] Bagul R,Chandan S,Sane VD,et al. Comparative evaluation of C-re-active protein and WBC count in fascial space infections of odonto-genic origin[J]. J Maxillofac Oral Surg,2017,16(2):238-242.
[13] Straatman J,Cuesta MA,Gisbertz SS,et al. Value of a step-up diag-nosis plan:CRP and CT-scan to diagnose and manage postoperativecomplications after major abdominal surgery[J]. Rev Esp EnfermDig,2014,106(8):515-521.
[14]吴姗姗,严峰,邓玉玲,等.小细胞和非小细胞肺癌晚期患者CD3+CD4+及CD3+CD8+T淋巴细胞亚群的差异[J].中国免疫学杂志,2015,31(1):114-116.
[15]吴高亮,谢梅茂,周伟敏,等.不同途径肾癌根治术对患者T淋巴细胞亚群的影响[J].中国老年学杂志,2016,36(24):6157.
[2]张建平,朱煜,林宗明,等.肾癌伴膈下型癌栓的手术治疗[J].中华泌尿外科杂志,2013,34(5):329-332.
[3]马鑫,刘新,郑涛,等.肾动脉低温灌注联合腹腔镜肾部分切除术处理复杂肾肿瘤的初步经验[J].微创泌尿外科杂志,2014,3(2):80-83.
[4]李晓红.腹腔镜保留肾单位肾肿瘤切除术与根治性肾切除术对肾细胞癌患者术后肾功能及生存质量影响分析[J].临床误诊误治,2017,30(2):95-98.
[5]王英磊,李忠海,刘庆鹏,等.腹腔镜下肾部分切除术治疗肾肿瘤的临床研究[J].中国医学前沿杂志(电子版),2014,6(8):104-107.
[6]徐虎,王贵荣,张治国,等.后腹腔镜与开放手术行肾部分切除术的疗效比较[J].现代泌尿外科杂志,2016,21(5):346-348.
[7]刘哲,陈佳.后腹腔镜肾部分切除术和开放肾部分切除术治疗肾肿瘤的疗效比较[J].中国肿瘤临床与康复,2014,21(12):1482-1484.
[8]周建军,李学明,曹国灿,等.经腹入路腹腔镜肾盂成形术治疗儿童肾盂输尿管连接部梗阻[J].临床小儿外科杂志,2014,13(6):506-509.
[9]王庆杰,刘贵中,孙光,等.后腹腔镜肾部分切除术治疗T1b期肾癌17例报告[J].天津医药,2014,42(1):88-89.
[10]马鑫,郑涛,史涛坪,等.肾血管低温灌注下后腹腔镜肾部分切除术处理2例复杂左侧肾肿瘤[J].微创泌尿外科杂志,2013,2(3):222-224.
[11]蒲小勇,徐战平,刘久敏,等.两种入路腹腔镜下肾部分切除术治疗R. E. N. A. L.评分≥7的肾肿瘤的比较研究[J].南方医科大学学报,2014,34(12):1818-1821.
[12] Bagul R,Chandan S,Sane VD,et al. Comparative evaluation of C-re-active protein and WBC count in fascial space infections of odonto-genic origin[J]. J Maxillofac Oral Surg,2017,16(2):238-242.
[13] Straatman J,Cuesta MA,Gisbertz SS,et al. Value of a step-up diag-nosis plan:CRP and CT-scan to diagnose and manage postoperativecomplications after major abdominal surgery[J]. Rev Esp EnfermDig,2014,106(8):515-521.
[14]吴姗姗,严峰,邓玉玲,等.小细胞和非小细胞肺癌晚期患者CD3+CD4+及CD3+CD8+T淋巴细胞亚群的差异[J].中国免疫学杂志,2015,31(1):114-116.
[15]吴高亮,谢梅茂,周伟敏,等.不同途径肾癌根治术对患者T淋巴细胞亚群的影响[J].中国老年学杂志,2016,36(24):6157.