發(fā)布時間：2018-04-19 12:24

  本文選題：腹膜后 + 腹腔鏡　； 參考：《南華大學(xué)》2014年碩士論文

【摘要】：目的本實驗通過設(shè)立經(jīng)腹膜外途徑腰部第12肋下斜切口行腎全切除術(shù)為對照組，經(jīng)腹膜后腹腔鏡腎切除術(shù)為觀察組，測定二種手術(shù)方式患者在手術(shù)前、手術(shù)中、手術(shù)后1天及手術(shù)后第4天所測得的紅細(xì)胞C3b受體花環(huán)率和紅細(xì)胞免疫復(fù)合物花環(huán)率，通過觀察紅細(xì)胞CR1活性的影響變化，反應(yīng)紅細(xì)胞免疫功能的變化，最終達(dá)到探討腔鏡相對于開放手術(shù)的優(yōu)越性及紅細(xì)胞CR1活性在腹膜后腔鏡腎切除術(shù)后免疫狀態(tài)作用及其機(jī)制。 方法選取廣東省第二人民醫(yī)院就診患者中因良性疾病導(dǎo)致無功能腎并根據(jù)醫(yī)生建議，最終患者及家屬同意需行單側(cè)腎腎切除術(shù)患者30例，對其進(jìn)行分組治療，分為對照組與參照組，需擇期行腹膜后腔鏡腎切除術(shù)的15例（觀察組），其中男性8例，女性7例，患腎為左側(cè)腎6例，右側(cè)腎9例。所選病例均為良性疾病最終導(dǎo)致單側(cè)腎無功能，其中原發(fā)疾病有：泌尿系結(jié)石10例，腎囊腫2例，多囊腎2例，，先天性輸尿管腎盂交界處狹窄1例。腰部第11肋間斜切口行腎全切除術(shù)15例（對照組），其中男性10例，女性5例，患腎為左側(cè)腎7例，右側(cè)腎8例，所選病例均為良性疾病最終導(dǎo)致單側(cè)腎無功能，其中原發(fā)疾病有：泌尿系結(jié)石12例，腎囊腫1例，多囊腎2例。所有患者年齡在40至60歲之間，無心、腦、肺、肝系統(tǒng)的疾患或其他合并癥者；術(shù)前測血肌酐在55～110umol/L；近3月內(nèi)未服用激素類藥物及其他影響免疫的藥物。記錄患者術(shù)前、術(shù)中、術(shù)后一般情況，包括術(shù)前體溫、脈搏、血壓，術(shù)中體溫、血壓、脈搏、術(shù)中出血情況、手術(shù)麻醉時間，術(shù)后并發(fā)癥率，術(shù)后胃腸功能恢復(fù)情況，拔除引流管時間，術(shù)后住院時間。 采用非隨機(jī)方式留取術(shù)前、術(shù)中、術(shù)后1d和術(shù)后4d不同時段紅細(xì)胞1型補(bǔ)體受體花環(huán)率(RBC-C3bRR)、紅細(xì)胞免疫復(fù)合物花環(huán)率(RBC-ICR)（所檢測方法均采用郭峰法檢測），觀察兩組數(shù)據(jù)不同點，最終將取得的實驗數(shù)值進(jìn)行統(tǒng)計學(xué)處理。 所有結(jié)果均采用統(tǒng)計軟件進(jìn)行系統(tǒng)化統(tǒng)計分析。計量資料同一指標(biāo)不同時間段比較采用配對t檢驗，兩組間比較采用獨立樣本t檢驗，計數(shù)資料采用四格表的χ2分析，P0.05認(rèn)為差異有統(tǒng)計學(xué)意義。（統(tǒng)計軟件為SPSS18.0） 結(jié)果1．患者一般情況：兩組患者術(shù)前體溫、脈搏、血壓，觀察組（腔鏡組）術(shù)前分別為：36.52±0.32℃、73±8次/分、122±15/80±6mmHg，術(shù)中分別為：36.42±0.41℃、85±21次/分、125±21/83±7mmHg，術(shù)后1d分別：37.12±0.53℃、89±18次/分、127±19/82±5mmHg，術(shù)后4d分別為：36.42±0.41℃、75±9次/分、123±18/81±8mmHg，對照組（開放組）術(shù)前分別為：36.42±0.21℃、74±7次/分、123±13/81±5mmHg，術(shù)中分別為：36.34±0.52℃、84±22次/分、125±21/83±7mmHg，術(shù)后1d分別：37.77±0.52℃、89±19次/分、127±19/82±5mmHg，術(shù)后4d分別為：36.42±0.22℃、76±7次/分、123±18/81±8mmHg，兩組比較P=0.71，無顯著差異。兩組手術(shù)術(shù)中、術(shù)后均無手術(shù)并發(fā)癥，觀察組（腔鏡組）手術(shù)順利，無轉(zhuǎn)中轉(zhuǎn)開放手術(shù)，術(shù)中出血量少，術(shù)中統(tǒng)計出血量為：50.30±20.33ml，對照組（開放組），術(shù)中統(tǒng)計出血量為：100.74±30.72ml，有統(tǒng)計學(xué)意義（P=0.032）。手術(shù)麻醉時間觀察組（腔鏡組）：108.31±42.46min低于對照組（開放組）：125.41±40.34min，有統(tǒng)計學(xué)差異（P=0.023），胃腸功能恢復(fù)時間：腔鏡組平均排氣時間為26.21±11.74h，明顯低于開放組的42.21±14.71h，有明顯差異（P=0.018），術(shù)后拔除引流管時間觀察組（腔鏡組）：54.21±10.74h低于對照組（開放組）：72.21±11.72h，有顯著差異，（P=0.021）術(shù)后住院時間腹腔鏡組平均為6天，短于開腹組(10天)。2. CR1活性測量：對照組的RBC-C3bRR值在術(shù)前、術(shù)中、術(shù)后1d、術(shù)后4d分別為：23.41±5.11、5.35±1.01、6.74±2.08、14.55±4.51；觀察組為：23.42±4.41、10.25±2.66、12.58±3.15、19.38±5.51；對照組RBC-ICR值在術(shù)前、術(shù)中、術(shù)后1d、術(shù)后4d分別為：11.56±3.01、26.77±6.25、29.78±9.18、27.44±5.84；觀察組為：11.26±2.31、17.77±5.75、19.48±5.88、16.25±6.55。兩組患者RBC-C3bRR和RBC-ICR在術(shù)中、術(shù)后1d、術(shù)后4d測定比較上存在著顯著性差異，P0.05，具有統(tǒng)計學(xué)意義。 結(jié)論1、腹膜后腔鏡下腎切除手術(shù)中出血少、術(shù)后胃腸恢復(fù)快、留置創(chuàng)腔引流管時間短，住院天數(shù)短等因素明顯提高了醫(yī)療質(zhì)量，減輕了患者痛苦。 2．腹膜后腔鏡腎切除術(shù)及開放式腰部切口腹膜后腎切除術(shù)均可造成紅細(xì)胞CR1活性下降。 3.腹膜后腔鏡腎切除術(shù)導(dǎo)致機(jī)體紅細(xì)胞CR1粘附活性的下降顯著低于開放組。
[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.

【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R699.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 亓玉忠,胡三元,孫昭輝,于文濱,禹化龍;腹腔鏡手術(shù)對腹腔內(nèi)環(huán)境的影響[J];中華普通外科雜志;2003年04期

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