后腹腔镜肾癌根治术的手术效果及对 外周血循环肿瘤细胞的影响

Clinical effects of retroperitoneal laparoscopic radical nephrectomy and its impact on peripheral blood circulating tumor cells

摘要:

摘要：目的 观察后腹腔镜肾癌根治术（RLRN）的手术效果及对外周血循环肿瘤细胞（CTCs）的影响。方法 对该院54例行手术治疗的肾癌患者的临床资料进行回顾性分析，根据术式分为RLRN组（n =28）和开放性肾癌根治术（ORN）组（n =26）。观察手术效果，在术前3 d（T1）、术后3 d（T2）及术后2周（T3）时，检测两组患者外周血CTCs及血清应激反应指标[皮质醇（Cor）和去甲肾上腺素（NE）]水平，观察并发症发生情况。结果 两组手术时间比较差异无统计学意义（P >0.05）；RLRN组术中出血量、肠功能恢复时间及住院时间均少于ORN组（P <0.05）。在T1～T3时，两组外周血CTCs阳性率比较差异无统计学意义（P >0.05）；RLRN组外周血CTCs阳性患者T2和T3时点外周血CTCs水平低于ORN组（P <0.05）。T1～T3时，两组血清Cor和NE水平均于T2时上升、T3时降低，两组上述组间效应、时间点效应及组间与时间点交互效应比较，差异均有统计学意义，RLRN组波动幅度小于ORN组（P <0.05）。RLRN组并发症发生率小于ORN组（P <0.05）。结论 RLRN相对于ORN，可有效改善手术效果，降低术后早期外周血CTCs水平，减轻应激反应，减少并发症发生率，更具优势。

Abstract:

Abstract: Objective To observe the clinical effects of retroperitoneal laparoscopic radical nephrectomy (RLRN) and its impact on peripheral blood circulating tumor cells (CTCs). Methods Clinical data of 54 patients with renal carcinoma who underwent surgery were retrospectively analyzed. According to the procedure, they were divided into RLRN group (n = 28) and open renal radical nephrectomy (ORN) group (n = 26). The surgical effects were observed. Peripheral blood CTCs and serum stress response indicators [cortisol (Cor), norepinephrine (NE)] were measured at 3 d before operation (T1), 3 d after operation (T2) and at 2 weeks after operation (T3). The occurrence of complications was observed. Results There was no significant difference in the operative time between the two groups (P > 0.05). The intraoperative blood loss, intestinal function recovery time and hospital stay in RLRN group were smaller than those in ORN group (P < 0.05). There was no significant difference in the positive rate of peripheral blood CTCs between the two groups at T1 ~ T3 (P > 0.05). The peripheral blood CTCs level in the peripheral blood CTCs positive patients in RLRN group at T2 and T3 point was lower than that in ORN group (P < 0.05). At T1 ~ T3, the levels of serum Cor and NE in the two groups were increased at T2 and decreased at T3, and there were statistically significant differences in the between-group effect, time-point effect and interaction effects of between-group and time-point of the above-mentioned indexes between the two groups, and the fluctuation range in RLRN group was smaller than that in ORN group (P < 0.05). The incidence rate of complications in RLRN group was lower than that in ORN group (P < 0.05). Conclusions Compared woth ORN, RLRN can effectively improve the surgical effects, reduce the levels of peripheral blood CTCs, relieve stress response and reduce the incidence rate of complications, and it is more advantageous.