文章摘要

经腹腹腔镜肾癌根治术对患者免疫功能及预后的影响

作者: 1周利旺, 2周家权, 1吴维剑
1 定安县人民医院外一科,海南 定安 571200
2 海南省人民医院(海南医学院附属海南医院)泌尿外科,海口 570311
通讯: 周利旺 Email: 99985752@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.09.028

摘要

目的:探讨经腹腹腔镜肾癌根治术(laparoscopic radical nephrectomy,LRN)对患者免疫功能及预后的影响。方法:回顾性分析2015年1月至2017年12月间收治的102例行根治术的肾癌患者临床资料,根据手术方式将患者分为观察组(n=48)和对照组(n=54)。观察组行LRN,对照组行开放肾癌根治术(open radical nephrectomy,ORN)。比较两组围术期情况,包括手术时间、术中出血量、术后胃肠功能恢复情况及术后住院时间;术前、术后5 d评估患者肾功能[尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)]、免疫功能(T淋巴细胞亚群)、肿瘤标志物[癌胚蛋白(carcinoembryonic antigen,CEA)、糖类抗原125(carbohydrate antigen 125,CA125)及糖类抗原50(carcinoma antigen50,CA50)],记录患者手术并发症发生率、1年预后情况。结果:两组手术时间差异无统计学意义(P>0.05),观察组术中出血量、术后胃肠功能恢复时间、术后住院时间均优于对照组(P<0.05)。术后5 d,两组BUN,SCr均高于术前(P<0.05),两组组间差异无统计学意义(P>0.05)。术后5 d,两组CD4+,CD8+,CD4+/CD8+均低于术前(P<0.05),观察组降幅小于对照组(P<0.05)。术后5 d,两组CEA,CA125,CA50均低于术前(P<0.05),两组组间差异无统计学意义(P>0.05)。两组手术并发症发生率差异无统计学意义(P>0.05)。结论:LRN可达到与ORN相近的疗效、预后,且围术期状况更佳,对术后近期免疫功能影响小。
关键词: 肾癌;肾癌根治术;腹腔镜

Effects of transabdominal laparoscopic radical nephrectomy on immune function and prognosis of patients

Authors: 1ZHOU Liwang, 2ZHOU Jiaquan, 1WU Weijian
1 First Department of Surgery, Ding’an People’s Hospital, Ding’an Hainan 571200, China
2 Department of Urinary Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China

CorrespondingAuthor: ZHOU Liwang Email: 99985752@qq.com

Abstract

Objective: To explore the effects of transabdominal laparoscopic radical nephrectomy (LRN) on immune function and prognosis of patients. Methods: The clinical data of 102 patients with renal cell carcinoma who underwent radical resection from January 2015 to December 2017 were retrospectively analyzed. The patients were divided into an observation group (n=48) and a control group (n=54) according to the surgical methods. Observation group was given LRN and the control group was given open radical nephrectomy (ORN). The perioperative conditions (surgery time, intraoperative bleeding, postoperative gastrointestinal function recovery, postoperative hospital stay) were compared between the two groups, and the renal function [blood urea nitrogen (BUN), serum creatinine (SCr)], immune function (T lymphocyte subsets) and tumor markers [carcinoembryonic protein (CEA), carbohydrate antigen 125 (CA125), carbohydrate antigen 50 (CA50)] were evaluated before surgery and at 5 d after surgery, and the incidence rate of surgical complications and 1-year prognosis were recorded. Results: There was no significant difference in the operative time between the two groups (P>0.05), and the intraoperative bleeding, postoperative gastrointestinal function recovery time and postoperative hospital stay in observation group were lower than those in control group (P<0.05). At 5 d after operation, the BUN and SCr in the two groups were higher than those before operation (P<0.05), and there were no significant differences between the two groups (P>0.05). At 5 d after surgery, the CD4+, CD8+ and CD4+/CD8+ in the two groups were lower than those before surgery (P<0.05), and the decreases in observation group were smaller than those in control group (P<0.05). At 5 d after operation, the CEA, CA125 and CA50 in the two groups were lower than those before surgery (P<0.05), and there were no statistically significant differences between the two groups (P<0.05). There was no significant difference in the incidence rate of surgical complications between the two groups (P>0.05). Conclusion: LRN can achieve similar efficacy and prognosis with ORN, and it has better perioperative conditions and has little effect on the recent immune function.
Keywords: renal cancer; radical nephrectomy; laparoscopy