摘要【目的】探讨后腹腔镜肾癌根治术对患者围术期肝肾功能及心肌酶谱的影响。【方法】本院接受手术治疗的80例肾癌患者,其中行后腹腔镜肾癌根治术42例为观察组,行开放性肾癌根治术38例为对照组,比较两组围术期肝功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)]、肾功能[血尿素氮(BUN)、血肌酐(Cr)]及心肌酶谱[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]及炎性因子指标变化及两组手术情况。【结果】观察组术中出血量、住院时间、并发症发生率均明显优于对照组(P＜0.05)。与术前比较,观察组术后24 h ALT、AST、BUN、Cr、CK、CK-MB、LDH无显著变化(P＞0.05),而对照组术后24 h ALT、AST、LDH均显著上升(P＜0.05);两组术后24 h ALT、AST、LDH比较差异无显著性(P＜0.05)。与术前比较,两组术后24 h TNF-α、IL-6、CRP均显著上升(P＜0.05),且观察组上述指标均明显低于对照组(P＜0.05)。【结论】后腹腔镜肾癌根治术具有创伤小、术后恢复快、并发症少特点,对患者肝肾功能及心肌酶谱影响不大,同时对炎性因子的影响相比开放手术小。
Abstract：【Objective】To investigate the effect of retroperitoneal laparoscopic radical nephrectomy on liver,renal function and myocardial enzymes in patients with in perioperative period. 【Methods】A total of 80 patients with renal carcinoma who received surgical treatment in our hospital were analyzed.Forty two cases undergoing retroperitoneal laparoscopic radical nephrectomy were enrolled in the observation group, and 38 cases undergoing open radical nephrectomy were enrolled in the control group. The changes of liver function (ALT,AST), renal function (BUN,Cr ), myocardial enzymes (CK,CK-MB,LDH) and inflammatory factors (CRP,TNF-α, IL-6 ) were compared between the two groups. The operation complications in the two groups were recorded. 【Results】The intraoperative blood loss, hospitalization time and incidence of complications in the observation group were significantly less and lower than those in the control group (P<0.05). There were no significant level changes of ALT, AST, BUN, Cr, CK, CK-MB and LDH in observation group between pre and 24h post operation (P>0.05). While levels of ALT, AST and LDH at 24h post-operation in the control group were increased significantly (P<0.05). At 24h post-operation, the differences in ALT, AST and LDH between the two groups were significant (P<0.05). The levels of TNF-α, IL-6 and CRP at 24h post-operation in the two groups were significantly higher than those before operation (P<0.05), however, the above indexes in observation group were significantly lower than those in the control group (P<0.05). 【Conclusion】Retroperitoneal laparoscopic radical nephrectomy has the advantages of minimal trauma, faster postoperative recovery and few complications. It has little effect on hepatic and renal function as well as myocardial enzymes. Meanwhile, it has less influence on inflammatory factors, if compared to open operation.
2017, Vol. 34 
