【摘要】 目的探讨后腹腔镜微创手术对局限性原发性肾癌患者免疫与神经内分泌功能的影响。方法选择82例局限性原发性肾癌患者为研究对象,采用随机数字表法将患者分为观察组和对照组,每组41例。观察组患者接受后腹腔镜微创手术治疗,对照组患者接受传统开放式肾癌根治术治疗。记录并比较两组患者的手术时间、术中出血量、术后下床时间和住院时间,分析手术前后两组患者T淋巴细胞亚群指标和神经内分泌激素水平的变化情况。结果观察组患者的术中出血量少于对照组患者,手术时间、术后下床时间和出院时间均短于对照组患者,差异均有统计学意义(P﹤0.05)。术前,两组患者的T淋巴细胞亚群指标与神经内分泌激素水平比较,差异均无统计学意义(P﹥0.05)。术后第1天,两组患者的CD3+、CD4+和胰岛素水平均低于本组术前,皮质醇、促肾上腺皮质激素(ACTH)水平均高于本组术前,且观察组患者的CD3+、皮质醇和ACTH水平均高于对照组,胰岛素水平低于对照组,差异均有统计学意义(P﹤0.05)。术后第5天,观察组患者的CD3+、CD8+水平均低于本组术前,CD4+/CD8+比值高于本组术前,对照组患者的CD3+水平低于本组术前,且观察组患者的CD3+水平、CD4+/CD8+比值和胰岛素水平均高于对照组患者,CD8+水平、皮质醇和ACTH水平均低于对照组,差异均有统计学意义(P﹤0.05)。结论后腹腔镜微创手术治疗局限性原发性肾癌具有出血少、手术创伤小等优点,且对患者免疫功能和神经内分泌功能的影响较小。更多还原

【Abstract】 Objective To investigate the effect of laparoscopic minimally invasive surgery on the immune and neuroendocrine function of localized primary renal carcinoma patients. Method The study included 82 patients with primary renal carcinoma, who by a random number table were randomized as study or control group, each was with 41 patients, receiving laparoscopic minimally invasive surgery, or traditional open surgery for radical resection of renal cell carcinoma.The operative time, intraoperative blood loss, postoperative ambulation time and hospital stay of these patients were recorded, in addition, the changes of T lymphocyte subsets and neuroendocrine hormones were measured and compared.Result In study group, the operative time, intraoperative blood loss, postoperative ambulation time and hospital stay were significantly less than that in the control group(P<0.05). Before operation, the level of T lymphocyte subsets and neuroendocrine hormones were similar between the two groups(P>0.05). In 1 d after surgery, the CD3+and CD4+as well as insulin level in both groups were significantly lower than that before surgery, while cortisol and ACTH level were significantly increased, and the CD3+, cortisol and ACTH in study group were higher, yet the insulin level was lower in study group compared with control group(P<0.05). In 5 days after surgery, the CD3+and CD8+were lower, but CD4+/CD8+value was elevated in study group compared with those before surgery; in control group, the CD3+level was decreased after surgery, additionally, the study group had higher level of CD3+, CD4+/CD8+and insulin than in control group, but reduced level of CD8+, cortisol and ACTH compared with study group, indicating statistically significant differences(P<0.05). Conclusion Laparoscopic minimally invasive surgery for local primary renal carcinoma is advantageous due to its relatively less blood loss and minimal surgical wounds, besides, it poses minor effects on patients’ immune and neuroendocrine function.更多还原