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目的:探讨后腹腔镜肾脏手术对机体应激的影响。方法:选取2011年1月~2013年12月本院泌尿外科住院拟行肾脏手术的患者69例,分为后腹腔镜肾脏手术组(39例)与开放性肾脏手术组(30例),分别检测两组患者术前、术后1 h、术后24 h、术后72h术后120 h体内促肾上腺皮质激素(ACTH)、皮质醇(COR)、C反应蛋白(CRP)的含量,进行对比分析。结果:后腹腔镜肾脏手术组、开放性肾脏手术组两组ACTH和COR水平差异均有统计学意义(F_(分组)=107.286,P=0.000;F_(分组)=9.092,P=0.004);各个时间点的ACTH和COR差异也有统计学意义(F_(时间)=221.454,P=0.000;F_(时间)=94.257,P=0.000),术后1 h两组的ACTH和COR均明显增高,术后24 h、术后72 h及术后120 h两组的ACTH和COR均明显降低,后腹腔镜肾脏手术组术后72 h ACTH和COR降至术前水平,开放性肾脏手术组术后120 h ACTH和COR降至术前水平;后腹腔镜肾脏手术组不同时间点ACTH和COR的变化幅度小于开放性肾脏手术组(F_(交互)=36.446,P=0.000;F_(交互)=7.271,P=0.000)。CRP比较,两组差异也有统计学意义(F_(分组)=41.526,P=0.000);各个时间点的CRP差异也有统计学意义(F_(时间)=405.201,P=0.000),术后1 h、术后24 h、术后72 h CRP持续升高,术后120 h CRP明显降低;后腹腔镜肾脏手术组不同时间点COR升高幅度小于开放性肾脏手术组(F_(交互)=14.111,P=0.000)。结论:后腹腔镜肾脏手术对机体应激反应的影响程度小于开放性肾脏手术,能较大程度地维护机体神经系统及内分泌系统的稳定,更有利于机体的恢复。
Objective: To investigate the effect of retroperitoneal laparoscopic surgery on body stress. Methods: From January 2011 to December 2013, 69 hospitalized patients undergoing urological surgery in urology department of our hospital were divided into three groups: retroperitoneal renal surgery group (n = 39) and open renal surgery group (n = 30) The levels of adrenocorticotropic hormone (ACTH), cortisol (COR) and C-reactive protein (CRP) were measured before operation, 1 h after operation, 24 h after operation and 72 h after operation in both groups analysis. Results: There were significant differences in ACTH and COR levels between the two groups after laparoscopic nephrectomy and open renal surgery (F_ (group) = 107.286, P = 0.000; F_ (group) = 9.092, P = 0.004) The differences of ACTH and COR at each time point were also statistically significant (F_ (time) = 221.454, P = 0.000; F_ (time) = 94.257, P = 0.000) ACTH and COR were significantly decreased at 24 h, 72 h and 120 h after operation in both groups, and the levels of ACTH and COR decreased to preoperative level at 72 h after laparoscopic nephrectomy in the open renal surgery group 120 h ACTH and COR decreased to the preoperative level; The changes of ACTH and COR in the laparoscopic kidney surgery group were less than those in the open renal surgery group (F_ (interaction) = 36.446, P = 0.000; F_ (interaction) = 7.271 , P = 0.000). (P_ (group) = 41.526, P = 0.000). There was also a significant difference in CRP between different time points (F_ (time) = 405.201, P = 0.000) , The CRP kept rising at 24 h and 72 h after operation, and the CRP decreased significantly at 120 h after operation. The increase of COR at different time points in laparoscopic renal surgery group was less than that in open renal surgery group (F_ (interaction) = 14.111, P = 0.000). Conclusion: The effect of retroperitoneal laparoscopic surgery on stress response is less than that of open kidney surgery. It can largely maintain the stability of the nervous system and endocrine system and is more conducive to the recovery of the body.