后腹腔镜与开放性肾肿瘤切除术治疗对肾肿瘤患者血清皮质醇、uPA、VEGF和IGF-1水平的影响

摘要

目的 探究后腹腔镜根治性肾切除术(RLRN)与开放性肾部分切除术(OPN)治疗对肾肿瘤患者血清皮质醇、尿激酶型纤溶酶原激活物(u PA)、血管内皮生长因子(VEGF)、胰岛素样生长因子-1(IGF-1)水平的影响.方法 将本医院肿瘤科2014年7月～2017年10月期间收治的120例肾肿瘤患者根据手术方法不同分为RLRN组80例、OPN组40例,记录所有患者手术进行情况,术前术后采集患者静脉血标本进行血清皮质醇、u PA、VEGF和IGF-1检测.结果 与OPN组相比,RLRN组手术时间与之接近,差异不明显(P＞0.05),但出血量明显少,术后肛门排气时间、置管时间及住院时间明显缩短,差异有统计学意义(P＜0.05).RLRN组切口感染、皮下气肿、肺部感染发生率依次为2.50％、3.75％、1.25％,明显低于OPN组的15.00％、17.50％、10.00％,差异有统计学意义(P ＜0.05).两组术前血清皮质醇、u PA、VEGF和IGF-1水平差异不明显(P＞0.05),术后24h血清皮质醇明显升高,u PA、VEGF、IGF-1明显下降,但RLRN组皮质醇升高幅度明显较OPN组小,u PA、VEGF、IGF-1降低幅度明显较OPN组大,差异有统计学意义(P＜0.05).结论 与OPN相比,RL-RN治疗肾肿瘤患者除了术后恢复快及安全性高以外,还有助于改善患者术后血清皮质醇、u PA、VEGF和IGF-1水平.%Objective To explore the effects of retroperitoneal laparoscopic radical nephrectomy (RLRN) and open partial nephrectomy (OPN) on levels of serum cortisol, urokinase type plasminogen activator (uPA), vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) in patients with renal tumors.Methods 120 cases with renal tumors undergoing operation in different surgical ways during the period from July, 2014 to Oct., 2017 were selected and divided into 2 groups: RLRN group (n = 80) and OPN group (n = 40); operation data were recorded and detection of serum cortisol, uPA, VEGF and IGF-1 were applied to all the cases before and after operation.Results The operation time in RLRN group was of no obvious difference from that in OPN group (P＞0. 05) while the bleeding volume in operation, the time of postoperative anal exhaust, catheter indwelling and hospitalization in RLRN group were smaller and shorter than those in OPN group (P＜0. 05); the incidence of incision infection, subcutaneous emphysema and pulmonary infection in RLRN group were 2. 50％, 3. 75％ and 1. 25％ respectively, much lower than those in OPN group (15. 00％, 17. 50％, 10. 00％) (P＜ 0. 05); before operation, no obvious differences existed in the levels of serum cortisol, uPA, VEGF and IGF-1 between the 2 groups (P＞0. 05); 24 hours after operation, the level of serum cortisol in the 2 groups increased obviously and the levels of u PA, VEGF and IGF-1 decreased significantly, and a smaller increase in serum cortisol and a bigger decrease in uPA, VEGF and IGF-1 were found in RLRN group when compared with those in OPN group (P＜ 0. 05). Conclusions RLRN can promote a faster post-operative recovery with a higher safety that OPN and is of a greater help in improving the serum levels of cortisol, uPA, VEGF and IGF-1 of patients with renal tumors.