腹腔镜直肠癌Miles手术对机体应激反应和内脏蛋白的影响

目的:探讨腹腔镜直肠癌Miles手术对机体应激反应和内脏蛋白的影响。方法:将60例行直肠癌Miles手术的患者按其意愿分为腹腔镜组和开腹组,每组30例,于术前、术后第1、2、3天晨检测血C反应蛋白(CRP),IL-6及内脏蛋白,包括白蛋白(ALB)、前白蛋白(PRE)、转铁蛋白(TRF)、视黄醇结合蛋白(RBP)的变化。结果:两组CRP、IL-6术后1~3d较术前均明显升高(P<0.01),腹腔镜组术后CRP、IL-6明显低于开腹组(P<0.01)。两组术后ALB、PRE、TRF、RBP较术前明显下降(P<0.01)。术后第2天腹腔镜组PRE高于开腹组(P<0.01),术后第3天腹腔镜组ALB、PRE、TRF、RBP均明显高于开腹组(P<0.01)。结论:腹腔镜直肠癌Miles手术较开腹手术机体创伤及应激反应小,有利于机体内脏蛋白的恢复。     

腹腔镜直肠癌根治术对机体的炎性反应及免疫功能的影响

目的探讨腹腔镜手术治疗直肠癌对机体全身炎性反应和免疫机能的影响。方法将我院2004年11月～2006年11月收治的直肠癌39例随机分为腹腔镜手术组(19例)和开腹手术组(20例),分别在术前1d和术后1d及5d取外周血,测定白介素(IL)-6、肿瘤坏死因子(TNF)、C反应蛋白(CRP)及CD3 、CD4 、CD8 等各项指标并进行比较。结果开腹组术后第1d,IL-6、TNF及CRP明显高于腹腔镜组(P<0.01);术后第5d,IL-6、TNF两组间差异无统计学意义(P>0.05),但CRP下降缓慢,两组仍有差异(P<0.01)。开腹组术后第1d、5d,CD4 、CD8 细胞均明显低于术前(P<0.01)。而腹腔镜组术后第1d,CD4 、CD8 细胞下降低于开腹组(P<0.01);术后第5d,与术前相比无统计学差异(P>0.05)。结论腹腔镜手术治疗直肠癌的全身炎性反应较开腹手术者轻,且具有保护机体的免疫功能之优势。     

Systemic stress responses after laparoscopic or open hernia repair.

OBJECTIVE: To compare systemic stress responses after laparoscopic and open hernia repair to find out if the laparoscopic approach caused less stress than an open operation. DESIGN: Prospective randomised trial. SETTING: Teaching hospital, Sanliurfa, Turkey. SUBJECTS: 50 patients who required preperitoneal hernia repair were randomised to be treated by either the open or laparoscopic approach (n = 25 in each). INTERVENTIONS: Samples of venous blood were taken before operation and at 2, 24, and 48 hours afterwards for measurement of the concentrations of: glucose, cortisol, malonyldialdehyde (MDA), C-reactive protein (CRP), creatine phosphokinase (CPK), caeruloplasmin, transferrin, fibrinogen, and albumin, and counts of leucocytes, neutrophils, and lymphocytes. MAIN OUTCOME MEASURES: Changes in these indicators of a stress response. RESULTS: Concentrations of glucose, cortisol, CRP, MDA, and CPK, and counts of leucocytes and neutrophils increased significantly, and the concentration of albumin decreased significantly, in both groups postoperatively. Lymphocyte counts were lower postoperatively but not significantly so. Concentrations of CRP, MDA, and CPK, and leucocyte counts were significantly lower in the laparoscopic group. CONCLUSION: These findings suggest that there is less systemic stress response after laparoscopic than after open hernia repair.     

腹腔镜和开腹结直肠手术的炎性反应比较

目的对比分析腹腔镜和开腹结直肠手术患者全身和腹腔炎性反应的差异,为腹腔镜手术对结直肠肿瘤中的应用提供理论依据。方法对51例2004年4-8月间收治的乙状结肠和直肠恶性肿瘤患者,采用腹腔镜辅助手术25例(LAP组),开腹手术26例(OPEN组)。术毕骶前留置引流管。观察并比较两组患者的一般情况和炎性反应及与手术相关的各项指标。结果两组患者在年龄、性别、ASA分级、术前血红蛋白及白蛋白水平、肿瘤Dukes分期和手术方式差异均无统计学意义(P＞0．05)。在切口长度、手术时间、肠道功能恢复时间、住院时间的比较中,LAP组占有明显优势(P＜0．05)。腹腔引流量在术后第1天,两组间差异无统计学意义(P＞0．05)；而术后2-4 d,LAP组明显低于OPEN组(P＜0．05)。LAP组术后第1天,周围血中性粒细胞[(7．30±2．62)×10~9/L]、白介素(IL)-10[(19．46±3．31)pg/ml]和C反应蛋白(CRP)[(2．76±2．17)mg/dl]水平均显著低于OPEN组(P＜0．05)。术后第4天两组间差异无统计学意义(P＞0．05)。术后第1天,两组腹腔引流液的IL-10、肿瘤坏死因子(TNF)及CRP水平差异无统计学意义(P＞0．05),术后第4天LAP组IL-10 [(22．53±15．47)pg/ml]明显低于OPEN组(P＜0．05)。结论术后早期,腹腔镜结直肠手术的腹腔炎性反应与开腹手术相当,而全身炎性反应较开腹手术轻。腹腔镜结直肠手术临床上体现出恢复快、并发症少、住院天数少的优势。     

腹腔镜下行保留肾单位的肾肿瘤切除术对患者氧化应激反应以及红细胞糖代谢的影响

目的 分析腹腔镜下行保留肾单位肾肿瘤切除术对患者氧化应激反应以及红细胞糖代谢的影响.方法 选择接受手术治疗的肾肿瘤患者作为研究对象,按照手术方式不同分为观察组(腹腔镜手术)及对照组(开放性手术).检测分析两组患者的围术期氧化应激反应、红细胞糖代谢水平、微炎症水平等差异.结果 观察组患者接受腹腔镜手术治疗后的丙二醛(MDA)、皮质醇(Cor)水平低于对照组,谷胱甘太(GSH)、超氧化物歧化酶(SOD)水平高于对照组患者(P＜0.05);观察组患者的术后磷酸果糖激酶(PEK)水平高于对照组,红细胞6-磷酸葡萄糖胱氢酶(G-6PD)及醛糖还原酶(AR)水平低于对照组患者(P＜0.05);观察组患者的术后C反应蛋白(CRP)、IL-6、TNF-α水平低于对照组患者(P＜0.05).结论 腹腔镜下手术可以有效减少手术过程中的氧化应激反应,优化红细胞糖代谢,降低全身炎症反应,相较于开放性手术具有更多优势.     

The influence of CO2 versus helium insufflation or the abdominal wall lifting technique on the systemic immune response

BACKGROUND: Both laparoscopic and conventional surgery result in activation of the systemic immune response; however, the influence of the laparoscopic approach, using CO2 insufflation, is significantly less. Little is known about the influence of alternative methods for performing laparoscopy, such as helium insufflation and the abdominal wall lifting technique (AWLT), and the systemic immune response. METHODS: Thirty-three patients scheduled for elective cholecystectomy were randomly assigned to undergo laparoscopy using either CO2 or helium for abdominal insufflation or laparoscopy using only the AWLT. The postoperative inflammatory response was assessed by measuring the white blood cell count, C-reactive protein (CRP) and interleukin-6 (IL-6). The postoperative immune response was assessed by measuring monocyte HLA-DR expression. RESULTS: CRP levels were significantly higher 1 day after helium insufflation when compared with CO2 insufflation; however, no differences were observed 2 days after surgery. The AWLT resulted in significantly higher levels of CRP both 1 and 2 days after surgery when compared with either CO2 or helium insufflation. A small increase in postoperative IL-6 levels was observed in all groups, but no significant differences were seen between the groups. After both helium insufflation and AWLT a significant decrease in HLA-DR expression was observed, in contrast to the CO2 group. CONCLUSION: Carbon dioxide used for abdominal insufflation seems to limit the postoperative inflammatory response and to preserve parameters reflecting the immune status. These findings may be of importance in determining the preferred method of laparoscopy in oncologic surgery.     

高龄患者腹腔镜结直肠癌根治术对机体应激及内脏蛋白的影响

目的:研究高龄患者腹腔镜与开腹结直肠癌根治术围手术期IL-6、IL-10和C反应蛋白(C-reactive protein,CRP)及内脏蛋白的差异。方法:按患者意愿将41例行结直肠癌根治术的高龄患者分为腹腔镜组(n=20)和开腹组(n=21),两组患者的年龄、性别、体重指数(BMI)等差异无统计学意义,具有可比性,检测两组患者术前、术后的应激指标:血清IL-6、IL-10、CRP及内脏蛋白:前白蛋白(prealbumin,PRE)、转铁蛋白(transferrin,TRF)、视黄醇结合蛋白(retinal-binding protein,RbP)的变化。结果:两组患者CRP在术后1、2、3d均较术前明显升高(P0.01),术后第2天达峰值,腹腔镜组术后CRP明显低于开腹组(P0.01);两组患者血清IL-6、IL-10术后明显升高,腹腔镜组明显低于开腹组(P0.01),IL-10升高持续时间短。术后两组PRE、TRF、RbP均较术前明显下降(P0.01),术后1、2d两组各项指标差异无统计学意义(P0.05),术后第3天腹腔镜组4种蛋白指标均明显高于开腹组(P0.01)。结论:本组高龄患者术后应激水平及内脏蛋白指标的结果显示,腹腔镜结直肠癌根治术较开腹手术创伤小,应激水平低,有利于机体内脏蛋白的恢复,这对实施微创外科是有力的支持。     

手助腹腔镜与开腹巨脾切除术对机体应激反应的影响

目的:总结手助腹腔镜与开腹巨脾切除术对患者术后机体应激反应的影响。方法:随机选取2006年8月至2011年10月40例巨脾患者,根据其经济状况及意愿分为两组,每组20例,分别行手助腹腔镜脾切除术(hand-assisted laparo-scopic splenectomy,HALS)及传统开腹脾切除术(open splenectomy,OS),对比分析两组患者术前、术后皮质醇(cortisol,COR)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、C-反应蛋白(C-reactive protein,CRP)水平。结果:术后1天HALS组COR、TNF-α、IL-6、CRP水平均低于OS组(P<0.05),术后3天TNF-α、CRP水平低于OS组(P<0.05),术后5天CRP低于OS组(P<0.01)。结论:相对开腹手术而言,手助腹腔镜巨脾切除术对患者术后机体应激反应的影响较小,充分显示了其微创的优越性。     

成人腹股沟疝开放及腹腔镜术后炎性反应及并发症比较

目的探讨开放式以及腹腔镜手术方式对成人腹股沟疝患者炎性反应及相关并发症的影响差异。 方法选择2020年1月至2021年12月,在安徽省皖南康复医院·芜湖市第五人民医院完成腹股沟疝手术的60例患者的数据资料,进行回顾性分析。依手术方法分为对照组和观察组,各30例。对照组采用开放无张力疝修补术,观察组采用腹腔镜经腹腹膜前疝修补术（TAPP）。对比2组患者的手术耗时、失血量、切口长度、肛门排气时间、总住院时间、总医疗费用、切口疼痛持续时间、术后12 h疼痛程度、术后并发症指标。对比2组患者术前以及术后48 h的血清炎性反应指标[C反应蛋白（CRP）,白介素-6、降钙素原]。 结果观察组的失血量、切口长度、肛门排气时间、总住院时间低于对照组,观察组的总医疗费用高于对照组（P<0.05）。2组手术耗时差异无统计学意义（P>0.05）。观察组切口疼痛时间、术后VAS评分均低于对照组（P<0.05）。2组患者术后并发症发生率差异无统计学意义（P>0.05）。术后48 h,2组患者的血清CRP、白介素-6、降钙素原均增高（P<0.05）,观察组患者的CRP、白介素-6、降钙素原水平低于对照组（P<0.05）。 结论腹腔镜经腹腹膜前疝修补术组织创伤程度低,术后恢复速度快,疼痛感低,安全性良好,有利于控制术后的炎性反应水平。     

腹腔镜直肠癌根治术的可行性、安全性及肿瘤根治性分析

目的:探讨腹腔镜直肠癌根治术的可行性、安全性及肿瘤根治效果。方法:随机选取2008年2月至2013年2月54例腹腔镜直肠癌根治术患者作为研究对象(腹腔镜组),另选取60例传统开腹直肠癌根治术患者作为对照(开腹组)。对比分析两组患者一般资料、手术时间、手术出血量、术中输血、术后并发症、术后恢复情况,以及手术前后炎性指标、免疫指标、肿瘤标志物变化、手术根治效果。结果:手术均顺利完成,腹腔镜组无一例中转开腹。两组患者一般资料差异无统计学意义(P>0.05);腹腔镜组手术时间长于开腹组,差异有统计学意义(t=5.124,P<0.05),手术出血量腹腔镜组少于开腹组,差异有统计学意义(t=8.108,P=0.000),术中输血两组差异无统计学意义(P>0.05);腹腔镜组术后恢复情况优于开腹组,差异有统计学意义(P<0.05)。术前CRP、CD4+、CD8+、CD4+/CD8+水平两组相比差异无统计学意义(P>0.05);术后第3天、第7天、第10天,腹腔镜组CRP、CD8+均低于开腹组,差异有统计学意义(P<0.05),腹腔镜组CD4+、CD4+/CD8+水平均高于开腹组,差异有统计学意义(P<0.05)。两组患者手术前后血清CA242、CEA、CA724、CA199含量及阳性率差异无统计学意义(P>0.05)。腹腔镜组术后并发症发生率低于开腹组(13%vs.23.3%),但差异无统计学意义(P>0.05)。两组标本长度、淋巴结清扫数量、各站淋巴结转移率、转移度差异无统计学意义(P>0.05)。结论:与开腹手术相比,腹腔镜直肠癌根治术具有安全性高、并发症少、术后住院时间短等优点,手术可行性高、肿瘤根治性彻底,可作为直肠癌根治性治疗的首选方案。     

腹腔镜结直肠癌手术对机体影响的探讨

目的探讨腹腔镜下结直肠癌手术的低侵袭性。方法将符合纳入研究对象标准的40例结直肠癌患者随机分成腹腔镜组(20例)和开腹组(20例),比较两组患者围手术期(术前、术后当天、术后第1、3、5d)的外周血白介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)、可溶性细胞间黏附分子(sICAM-1)、白细胞CD11b的变化。结果开腹组术后细胞因子(TNF-α、IL-6、IL-8)明显高于腹腔镜组(P<0.05)。开腹组术后6h、第1天时,sICAM-1的动态变化较腹腔镜组显著升高,开腹组外周血白细胞CD11b在术后6h降至最低(161.98±48.42),较腹腔镜组(189.51±46.45)明显低(P<0.05)。结论结直肠癌的腹腔镜手术比传统开腹手术对机体影响小,具有明显的低侵袭性。     

Systemic immunologic and inflammatory response after laparoscopic versus open nephrectomy: a prospective cohort trial

Abstract Purpose: To compare the dynamics of systemic inflammatory indices during laparoscopic nephrectomy (LN) and standard open donor nephrectomy. Patients and Methods: Participants in this cohort study were 54 adults without a history of renal surgery and no evidence of urinary tract infection who underwent transperitoneal LN (n=29) and open donor nephrectomy (n=25, control group). We recorded demographic characteristics, intraoperative parameters, and changes 24 hours postoperatively in systemic inflammatory and immunologic values (body temperature, concentrations of white blood cell count [WBC], C-reactive protein [CRP], interleukin [IL]-6, and tumor necrosis factor [TNF]-α), and compared the mean changes between groups. Results: Mean age was older in the LN group (45.6 vs 30.9 years; P<0.0001), and mean operative time was significantly shorter (83.1?min vs 101.6?min; P=0.004). Mean postoperative increase in IL-6 and body temperature in LN was significantly less than in control: For IL-6, 15.87 vs 29.09?pg/mL, P=0.03; for body temperature, +0.22°C vs +0.71°C, P=0.001). Mean postoperative increases in levels of other inflammatory markers (CRP, TNF-α, WBC) did not differ significantly. No statistical correlation was found between operative time and changes in IL-6, CRP, TNF-α, WBC, or body temperature. Conclusion: Based on the smaller increase in serum IL-6 as the most important indicator of surgical stress, the surgical trauma-induced immune dysfunction may be less intense after LN than open surgery. This may explain the smooth convalescence after LN.     

Changes in Leptin,Plasminogen Activator Factor and Oxidative Stress in Morbidly Obese Patients following Open and Laparoscopic Swedish Adjustable Gastric Banding

Background: Oxidative stress is increased in obesity, leading to endothelial dysfunction, atherogenesis, and platelet aggregation. The purpose of this study was to determine the effects of weight loss after bariatric surgery on serum lipids, malondialdehyde (MDA, a marker of oxidative stress), oxidized low-density lipoprotein (oxLDL, which is increased in obesity and causes endothelial dysfunction), paraoxonase (PON-1, which inhibits lipid peroxidation), leptin and plasminogen activator inhibitor type-1 (PAI-1, which contributes to a thrombotic state). Methods: 40 morbidly obese patients had insertion of a Swedish adjustable gastric band (SAGB). A lipid profile, MDA, oxLDL, PON-1, leptin and PAI-1 levels were drawn before and 6 months after the operation. 20 patients underwent open (Group 1) and 20 laparoscopic (Group 2) SAGB, to compare the systemic inflammatory response of the two approaches. Results: Patient demographics, indications for surgery, and postoperative results were no different between the groups. Postoperative BMI and concentrations of lipid, MDA, oxLDL, leptin and PAI-1 decreased significantly in both groups. PON-1 activity increased and was negatively correlated with BMI (r=-0.618, P< 0.01), MDA (r=-0.735, P<0.001), oxLDL (r=-0.701, P< 0.01), leptin (r=-0.626, P<0.01) and PAI-1 (r=-0.461, P<0.05). There was a correlation between BMI and MDA (r=0.790, P <0.001), and also leptin (r=0.900, P<0.001) and PAI-1 (r=0.888, P=0.001). There was no correlation between BMI and oxLDL. Conclusion: These findings support the hypothesis that in morbid obesity, weight loss after surgery has positive effects on fibrinolytic function, oxidative stress and antioxidant activity. Both operative approaches had similar effects in this study.     

结直肠癌腹腔镜切除术对机体应激反应影响的临床研究

目的　探讨结直肠癌患者行腹腔镜切除术后机体应激反应的变化。方法　选择同期腹腔镜下和常规的结直肠癌切除术患者各 30例进行前瞻性研究 ,比较两种术式术后的体温、止痛剂用量、肠蠕动恢复时间、C 反应蛋白、白细胞计数和白细胞介素 6 (IL 6 )的变化。结果　结直肠癌腹腔镜切除术组的术后体温和白细胞计数的变化与常规开腹组相比无统计学差异 ,而止痛剂用量、肠蠕动恢复时间、C 反应蛋白和术后第 1天IL 6水平均明显低于常规开腹组 (P<0 .0 1,P<0 .0 5 )。结论　结直肠癌腹腔镜切除术对机体应激反应的影响明显轻于常规开腹组 ,恢复早于常规开腹组 ,显示了微创的优越性     

腹腔镜治疗腹股沟斜疝对小儿血CRP、IL-6、IL-10的影响

目的探讨腹腔镜治疗小儿腹股沟斜疝手术前后外周血C反应蛋白（C-reactive protein,CRP）、白细胞介素6（IL-6）、白细胞介素10（IL-10）的变化。方法将50例腹股沟斜疝的患儿按抽签方式分为腹腔镜组和开放组各25例。腹腔镜组行腹腔内环口疝囊结扎术;开放组行腹股沟部切开疝囊高位结扎。于手术前1天早晨空腹、术后即刻、术后第2天早晨空腹采外周静脉血,用ELISA法测定血中的CRP、IL-6、IL-10的含量。结果2组术后即刻CRP、IL-6、IL-10比手术前有显著升高（腹腔镜组q=8.508、11.307、22.111,P〈0.05;开放组q=7.938、16.668、21.707,P〈0.05）;但开放组上述指标明显高于腹腔镜组（t=-3.106,P=0.005;t=-4.509,P=0.000;t=-4.745,P=0.000）。术后第2天,与术前相比,腹腔镜组CRP、IL-6、IL-10差异无显著性（q=0.086、0.482、3.853,P〉0.05）;而开放组仍高于术前（q=3.845、10.599、11.379,P〈0.05）。2组相比,开放组明显高于腹腔镜组（t=-3.130,P=0.005;t=-5.051,P=0.000;t=-3.730,P=0.001）。结论与开放手术相比,腹腔镜治疗腹股沟斜疝引起CRP、IL-6、IL-10的改变较小,因而,腹腔镜手术对小儿机体的免疫抑制作用小,持续时间短。     

腹腔镜与腹式全子宫切除术术后疲劳综合征的对比研究

目的:对比分析腹腔镜与腹式全子宫切除术术后疲劳综合征的特点。方法:126例患者根据手术方式分为腹腔镜组(58例)与开腹组(68例),分别于术前(T0),术后第1天(T1)、第3天(T2)、第5天(T3)进行Christensen疲劳评分、利势手握力测试,并抽取空腹静脉血化验白蛋白、转铁蛋白、前白蛋白、维A结合蛋白、C反应蛋白、IL-6、TNF-α和白细胞计数,将两组结果进行对比。结果:术前两组患者各项目差异均无统计学意义(P>0.05)。术后腹腔镜组各测试时间点疲劳评分较低,利势手握力较高,前白蛋白和维A结合蛋白较高,炎症指标水平较低,但两组血浆白蛋白和转铁蛋白差异无统计学意义(P>0.05)。结论:腹腔镜全子宫切除术可减轻术后炎症水平,减少对机体营养状态的影响,有效降低了患者术后疲劳综合征的严重程度,利于术后康复。     

Recovery of fasted and fed gastrointestinal motility after open versus laparoscopic cholecystectomy in dogs.

OBJECTIVE: The authors investigate the recovery of gastrointestinal motility in the fed and fasted state after laparoscopic and open cholecystectomy. SUMMARY BACKGROUND DATA: Clinical recovery after laparoscopic cholecystectomy is known to be more rapid than after conventional open cholecystectomy. However, the actual effect of a laparoscopic approach on gastrointestinal motility, particularly fed-state motility, is not well investigated. METHODS: Laparoscopic (LAP, n=6) or open (OPEN, n=6) cholecystectomy was performed in 12 dogs. Bipolar recording electrodes were placed on the antrum, small intestine, and the transverse and descending colon, and fasting myoelectric data were recorded after operation. Solid meal gastric emptying studies were performed before surgery and on postoperative days 1 and 2. Transit time studies were performed using 10 radiopaque markers. RESULTS: Gastric emptying was significantly delayed in the OPEN group at 120 minutes on postoperative day 1 compared with pre-operative emptying (p<0.05), but was not delayed on postoperative day 2. Gastric emptying was not delayed in the LAP group after operation. Transit time was the same between groups. Gastric dysrhythmias were more frequent on postoperative day 3 (p<0.05) in the OPEN group. There were no significant differences in the presence, cycle length, or propagation velocity of the migrating motor complex on any postoperative day. Discrete or continuous electrical response activity in the colon was observed by postoperative day 1 in both groups. CONCLUSIONS: Fed-state motility is the only parameter for which laparoscopic cholecystectomy showed an improvement in postoperative recovery. Recovery of fasted gastrointestinal motility in dogs is equally rapid after either operation.     

微型腹腔镜与传统开腹小儿肠套叠复位术的对比研究

目的:探讨腹腔镜肠套叠复位术治疗小儿肠套叠的价值.方法:回顾分析为55例患儿施行肠套叠复位术的临床资料,33例施行腹腔镜手术,22例施行开腹手术,测定、比较两组术前及术后血清IL-6、TNF-α和C反应蛋白的水平,并对比两组患儿手术时间、术后并发症及住院时间.结果:腹腔镜组术后CRP,TNF-α,IL-6水平低于开腹组...     

后腹腔镜肾癌根治术对患者术后疼痛及相关血液指标的影响研究

目的 观察后腹腔镜肾癌根治术与开放性肾癌根治术对患者术后疼痛及相关血液指标影响的差异.方法 以2012年5月至2015年5月在本院接受肾癌根治术的80例患者为研究对象,并随机分为对照组和观察组,每组各40例患者.其中对照组采取开放性肾癌根治术,观察组则给予后腹腔镜肾癌根治术.比较两组患者手术前后VAS得分和疼痛因子水平;比较两组患者手术前后血清中应激相关指标[白细胞数、血清皮质醇、甲状腺素和C-反应蛋白(CRP)]、肿瘤标志物(CA50、CEA、CA125)和炎症相关细胞因子水平的差异.结果 手术前两组患者VAS得分和5-HT水平无明显差异,术后第3天,由于手术创伤两组患者的VAS得分和5-HT水平均较术前明显升高,但观察组低于对照组(P＜0.05);术前两组患者的应激指标无明显差异,术后第3天,对照组白细胞数、皮质醇、CRP水平均高于观察组,而FT3和FT4水平低于观察组;观察组患者抑炎因子中IL-2高于对照组,IL-10和IL-13低于对照组,促炎因子IL-1β、IL-6和IL-12均低于对照组(P＜0.05).结论 与开放性肾癌根治术相比,后腹腔镜肾癌根治术在确保癌肿清除的同时,对机体炎性平衡状态的影响较小,并可减轻机体的氧化应激反应,对减轻患者术后疼痛、促进机体早日恢复有重要意义.     

三种疝修补术治疗老年腹股沟疝患者的临床疗效比较

目的探究疝环充填手术、Lichtenstein修补术与腹腔镜经腹腹膜前修补术对老年腹股沟疝患者临床疗效情况。 方法选取2018年1月至2020年2月在东南大学附属中大医院溧水分院进行治疗的150例老年腹股沟疝患者,随机分为A组（50例）、B组（50例）及C组（50例）。A组采用疝环充填修补术、B组采用Lichtenstein修补术、C组采用腹腔镜经腹膜前修补术,观察并记录3组患者的手术时间、术后下床活动时间、术后疼痛持续时间以及术后住院时间;分别于术后1 d、7 d,采用视觉模拟评分对患者进行疼痛评估;检测术前及术后3组患者炎性因子水平：C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）以及白细胞介素-6（IL-6）水平;记录患者术后6个月内并发症发生情况。 结果3组患者手术时间比较,差异无统计学意义（P>0.05）;C组术后下床活动时间、术后疼痛持续时间及术后住院时间显著低于A组和B组（P<0.01）,B组在术后疼痛持续时间上低于C组（P<0.05）;术后1 d、7 d,C组VAS评分低于A组及B组,A组VAS评分低于B组（P<0.05）;3组术后CRP、TNF-α以及IL-6水平均较术前显著升高,C组炎性因子水平均显著低于A组和B组（P<0.05）,B组术后IL-6水平低于A（P<0.05）;3组在术后6个月均未出现疝复发情况,A组并发症总发生率低于B组和C组（P<0.05）,B组术后发生神经感觉异常症状高于A组（P<0.05）,B组和C组并发症总发生率差异无统计学意义（P>0.05）。 结论腹腔镜经腹腹膜前修补术治疗老年腹股沟疝患者疗效较开放式无张力疝修补术更好,对老年患者损伤更小,使其术后恢复更快,安全性更高。