腹膜后腔镜肾切除术对红细胞CR1活性的影响

发布时间：2018-04-19 12:24

本文选题：腹膜后 + 腹腔镜　；参考：《南华大学》2014年硕士论文

【摘要】：目的本实验通过设立经腹膜外途径腰部第12肋下斜切口行肾全切除术为对照组，经腹膜后腹腔镜肾切除术为观察组，测定二种手术方式患者在手术前、手术中、手术后1天及手术后第4天所测得的红细胞C3b受体花环率和红细胞免疫复合物花环率，通过观察红细胞CR1活性的影响变化，反应红细胞免疫功能的变化，最终达到探讨腔镜相对于开放手术的优越性及红细胞CR1活性在腹膜后腔镜肾切除术后免疫状态作用及其机制。方法选取广东省第二人民医院就诊患者中因良性疾病导致无功能肾并根据医生建议，最终患者及家属同意需行单侧肾肾切除术患者30例，对其进行分组治疗，分为对照组与参照组，需择期行腹膜后腔镜肾切除术的15例（观察组），其中男性8例，女性7例，患肾为左侧肾6例，右侧肾9例。所选病例均为良性疾病最终导致单侧肾无功能，其中原发疾病有：泌尿系结石10例，肾囊肿2例，多囊肾2例，，先天性输尿管肾盂交界处狭窄1例。腰部第11肋间斜切口行肾全切除术15例（对照组），其中男性10例，女性5例，患肾为左侧肾7例，右侧肾8例，所选病例均为良性疾病最终导致单侧肾无功能，其中原发疾病有：泌尿系结石12例，肾囊肿1例，多囊肾2例。所有患者年龄在40至60岁之间，无心、脑、肺、肝系统的疾患或其他合并症者；术前测血肌酐在55～110umol/L；近3月内未服用激素类药物及其他影响免疫的药物。记录患者术前、术中、术后一般情况，包括术前体温、脉搏、血压，术中体温、血压、脉搏、术中出血情况、手术麻醉时间，术后并发症率，术后胃肠功能恢复情况，拔除引流管时间，术后住院时间。采用非随机方式留取术前、术中、术后1d和术后4d不同时段红细胞1型补体受体花环率(RBC-C3bRR)、红细胞免疫复合物花环率(RBC-ICR)（所检测方法均采用郭峰法检测），观察两组数据不同点，最终将取得的实验数值进行统计学处理。所有结果均采用统计软件进行系统化统计分析。计量资料同一指标不同时间段比较采用配对t检验，两组间比较采用独立样本t检验，计数资料采用四格表的χ2分析，P0.05认为差异有统计学意义。（统计软件为SPSS18.0）结果1．患者一般情况：两组患者术前体温、脉搏、血压，观察组（腔镜组）术前分别为：36.52±0.32℃、73±8次/分、122±15/80±6mmHg，术中分别为：36.42±0.41℃、85±21次/分、125±21/83±7mmHg，术后1d分别：37.12±0.53℃、89±18次/分、127±19/82±5mmHg，术后4d分别为：36.42±0.41℃、75±9次/分、123±18/81±8mmHg，对照组（开放组）术前分别为：36.42±0.21℃、74±7次/分、123±13/81±5mmHg，术中分别为：36.34±0.52℃、84±22次/分、125±21/83±7mmHg，术后1d分别：37.77±0.52℃、89±19次/分、127±19/82±5mmHg，术后4d分别为：36.42±0.22℃、76±7次/分、123±18/81±8mmHg，两组比较P=0.71，无显著差异。两组手术术中、术后均无手术并发症，观察组（腔镜组）手术顺利，无转中转开放手术，术中出血量少，术中统计出血量为：50.30±20.33ml，对照组（开放组），术中统计出血量为：100.74±30.72ml，有统计学意义（P=0.032）。手术麻醉时间观察组（腔镜组）：108.31±42.46min低于对照组（开放组）：125.41±40.34min，有统计学差异（P=0.023），胃肠功能恢复时间：腔镜组平均排气时间为26.21±11.74h，明显低于开放组的42.21±14.71h，有明显差异（P=0.018），术后拔除引流管时间观察组（腔镜组）：54.21±10.74h低于对照组（开放组）：72.21±11.72h，有显著差异，（P=0.021）术后住院时间腹腔镜组平均为6天，短于开腹组(10天)。2. CR1活性测量：对照组的RBC-C3bRR值在术前、术中、术后1d、术后4d分别为：23.41±5.11、5.35±1.01、6.74±2.08、14.55±4.51；观察组为：23.42±4.41、10.25±2.66、12.58±3.15、19.38±5.51；对照组RBC-ICR值在术前、术中、术后1d、术后4d分别为：11.56±3.01、26.77±6.25、29.78±9.18、27.44±5.84；观察组为：11.26±2.31、17.77±5.75、19.48±5.88、16.25±6.55。两组患者RBC-C3bRR和RBC-ICR在术中、术后1d、术后4d测定比较上存在着显著性差异，P0.05，具有统计学意义。结论1、腹膜后腔镜下肾切除手术中出血少、术后胃肠恢复快、留置创腔引流管时间短，住院天数短等因素明显提高了医疗质量，减轻了患者痛苦。 2．腹膜后腔镜肾切除术及开放式腰部切口腹膜后肾切除术均可造成红细胞CR1活性下降。 3.腹膜后腔镜肾切除术导致机体红细胞CR1粘附活性的下降显著低于开放组。
[Abstract]:Objective to determine the RBC C3b receptor rosette rate and erythrocyte immune complex of the erythrocyte C3b receptor in two patients before the operation, in the operation, 1 days after the operation and fourth days after the operation, by setting up the total nephrectomy of the lower lumbar oblique incision through the extraperitoneal approach as the control group and the retroperitoneal laparoscopic nephrectomy as the observation group. The rosette rate, by observing the changes in the activity of erythrocyte CR1, and the changes in the immune function of the red cell, finally reached the advantage of the endoscopy relative to the open operation and the role and mechanism of the immune state of the red cell CR1 activity after retroperitoneal laparoscopic nephrectomy.
Methods the non functional kidney caused by benign diseases in Guangdong No.2 People's Hospital was selected and the final patients and their families agreed to have 30 patients with unilateral nephrectomy. They were divided into the control group and the reference group, and 15 cases (observation group) needed to be selected for retroperitoneal laparoscopic nephrectomy. 8 cases, 7 cases of female, 6 cases of kidney as left kidney and 9 cases of right kidney. All cases were benign diseases which resulted in unilateral renal failure. The primary diseases included 10 cases of urinary calculi, 2 cases of renal cysts, 2 cases of polycystic kidney, 1 cases of congenital ureteropelvic junction stenosis, 15 cases (control group) with eleventh intercostal incision of the waist. 15 cases (control group) were performed. There were 10 male, 5 female, 7 left kidney and 8 right kidney. All the selected cases were benign diseases resulting in unilateral renal failure, of which 12 cases of urinary calculi, 1 cases of renal cyst and 2 cases of polycystic kidney were the primary diseases. All patients were between 40 and 60 years old, without heart, brain, lung, liver system or other complication. Blood creatinine was 55 to 110umol/L; no hormone drugs and other drugs affecting the immune system were taken in the last March. The preoperative, intraoperative and postoperative general conditions were recorded, including preoperative temperature, pulse, blood pressure, intraoperative temperature, blood pressure, pulse, intraoperative bleeding, postoperative anesthesia, postoperative complications, recovery of postoperative gastrointestinal function, extraction drainage. Time of management, time of postoperative hospitalization.
The RBC 1 type complement receptor rosette rate (RBC-C3bRR) and the red cell immune complex rosette rate (RBC-ICR) (all of the methods were detected by Guo Feng method) in different periods of 1D and 4D were used before and after the operation, and the data of the two groups were observed and the most final experimental values were statistically processed.
All the results were systematized statistical analysis using statistical software. The measured data were compared with the paired t test on the same index of the same index. The two groups were compared with the independent sample t test, the count data were analyzed by the chi 2 Analysis of four grid tables, and P0.05 thought the difference was statistically significant. (the system was SPSS18.0).
Results the general situation of 1. patients: pre operation temperature, pulse, blood pressure in the two groups were 36.52 + 0.32, 73 + 8 / minutes, 122 + 15/80 + 6mmHg, respectively, 36.42 + 0.41, 85 + 21 / min, 125 + 21/83 + 7mmHg, respectively, 37.12 + 36.52 + 7mmHg after operation, respectively, 73 36.42 + 0.41 C, 75 + 9 times / score, 123 + 18/81 + 8mmHg, and the control group (open group) before operation were 36.42 + 0.21, 74 + 7 / min, 123 + 13/81 + 5mmHg, respectively, respectively: 36.34 + 0.52, 84 + and 21/83 + 7mmHg, respectively, 1D: 19/82 + 19/82 + 5mmHg after operation The 76 + 7 times / score, 123 + 18/81 + 8mmHg, two groups compared with P=0.71, no significant difference. There were no surgical complications in the two groups, the observation group (endoscopic group) was smooth, no transfer open operation, less bleeding in the operation, the amount of bleeding in the operation was 50.30 + 20.33ml, the control group (open group), the statistical bleeding amount during the operation was 100.74 + 30.72ml, There was statistical significance (P=0.032). The:108.31 + 42.46min of the operation anesthesia time group (endoscopic group) was lower than that of the control group (open group):125.41 + 40.34min, with statistical difference (P=0.023), the recovery time of gastrointestinal function: the average exhaust time of the endoscopic group was 26.21 + 11.74h, obviously lower than that of the open group (42.21 + 14.71h), and there was a significant difference (P=0.018). The time observation group (:54.21 + 10.74h) was lower than the control group (open group):72.21 + 11.72h, and there were significant differences. (P=0.021) the average time of postoperative hospital stay was 6 days, shorter than that of the laparotomy group (10 days),.2. CR1 activity measurement: the RBC-C3bRR value of the control group was before the operation, during the operation, after the operation 1D, and the 4D after the operation was 23.41 + 5.11,5.35. 1.01,6.74 + 2.08,14.55 + 4.51, the observation group was 23.42 + 4.41,10.25 + 2.66,12.58 + 3.15,19.38 + 5.51, and the RBC-ICR value of the control group was before the operation, during the operation, and in the postoperative 1D, and the postoperative 4D was respectively 11.56 + 3.01,26.77 + 6.25,29.78 + 9.18,27.44 + 5.84, and the observation group was 11.26 + + + + + + two groups of patients. There were significant differences in RBC-ICR, 1D and 4D after operation, P0.05.
Conclusion 1, there are less bleeding in the retroperitoneal laparoscopic nephrectomy, quick recovery of gastrointestinal tract, short duration of indwelling drainage tube and short length of hospitalization, so as to improve the quality of medical treatment and reduce the pain of the patients.
2. retroperitoneal laparoscopic nephrectomy and open lumbar retroperitoneal nephrectomy can result in a decrease in erythrocyte CR1 activity.
3. retroperitoneal laparoscopic nephrectomy resulted in a decrease in erythrocyte CR1 adhesion activity, which was significantly lower than that in the open group.

【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

【参考文献】