后腹腔镜手术对患者神经内分泌激素的影响
摘要
目的:
探讨并比较泌尿外科腹膜后腹腔镜手术与传统开放手术对患者围手术期神经内分泌激素的影响。
方法:
选择我院2007年8月至2008年4月期间住院行手术治疗的泌尿系统疾病患者32例,年龄16～72岁,平均44.2±10.8岁。男18例,女14例。按手术方式不同分为两组,RL组(n=20),在腹膜后腹腔镜下手术,0组(n=12),行传统开放手术。两组年龄、性别、体重等条件相当。所有病例均无心脑血管疾病及内分泌功能异常,术前均经B超、CT等检查证实,手术后病理确诊。分别于手术前1天晨7时、手术开始后1小时、手术后第1天及手术后第2天晨7时抽取肘静脉血,应用放免法测定血清T_3、T_4、TSH、皮质醇(cortisol COR)、胰岛素(insulinINS)、胰高血糖素(glucogan GLU)的水平。实验结果应用SPSS11.0软件分析,采用重复测量数据的方差分析,以P＜0.05为有统计学意义。计量资料用(?)±s表示。
结果
两组手术前各项内分泌激素差异无显著(P＞0.05)。与术前比较,手术开始后1h、术后1d、2d各项激素水平均有所下降,两组间各项激素变化有同步性;手术后两组间比较,后腹腔镜组手术后各项激素的改变均小于开放手术组,但除术后第一天的T_3浓度0组明显低于RL组外(P=0.021),其余各时间点T_3、T_4、TSH、皮质醇、胰岛素(INS)、胰高血糖素(GLU)的浓度在两组间无统计学差异(P＞0.05)。
结论
本研究认为:①后腹腔镜手术和开放手术均对患者神经内分泌激素改变产生一定的影响。②后腹腔镜手术比开放手术对皮质醇的影响相对较小,但差异不大,说明两者对机体的创伤反应强度相当。③后腹腔镜手术比开放手术在胰岛功能的改变和应激反应程度上基本一致。④后腹腔镜手术对甲状腺应激反应影响较开放手术小。⑤与开放手术相比较,后腹腔镜手术的“微创”,不仅表现在切口微小,还表现在后腹腔镜组手术后各项内分泌激素的改变均小于开放手术组,有利于维护机体内环境的稳定。
Objective:To investigate the effects of retroperitoneal laparoscopic and conventional operation on neuroendocrine hormone of patients.
Methods:32 cases were divided into two groups according to the operative way: RL group received retroperitoneal laparoscopic operation(n=20) and O group underwent conventional operation(n=12).Blood samples were taken from vein preoperatively,at the 1 hour after operation,on the 1st day and 2nd day postoperatively.Serum cortisol(COR),insulin(INS),glucagon(GLU),T_3,T_4 and TSH concentrations were measured.The experimental data were analyzed by using a statistical softwere system SPSSI1.0.
Result:There was no significant difference between the two group in levels of T_3,T_4,TSH,INS,COR and GLU preoperatively(P＞0.05).Compared with the preoperative period,the levels of each hormone were decreased at every time points during or after operation in both groups,and the changes of each hormone in RL group were less than those of the O group.There was no significant difference between the two group in levels of T_4,TSH,INS,COR and GLU,but the levels of T_3 in O group was significantly lower than that in RL group on the 1st postoperative day(P＜0.05).
Conclusions:Urological retroperitoneal laparoscopic operation and conventional operation produce some effects on neuroendocrine hormone of the patients: Compared with the conventional operation,uroiogicai retroperitoneal laparoscopic operation produce less effects of 3,3',5-triiodothyronine on the patients,the difference was significant:and less effects of cortisol,T_4,TSH,INS and GLU,but the difference was not significant.Retroperitoneal laparoscopic operation induces a shorter stress response on patients.
探讨并比较泌尿外科腹膜后腹腔镜手术与传统开放手术对患者围手术期神经内分泌激素的影响。
方法:
选择我院2007年8月至2008年4月期间住院行手术治疗的泌尿系统疾病患者32例,年龄16～72岁,平均44.2±10.8岁。男18例,女14例。按手术方式不同分为两组,RL组(n=20),在腹膜后腹腔镜下手术,0组(n=12),行传统开放手术。两组年龄、性别、体重等条件相当。所有病例均无心脑血管疾病及内分泌功能异常,术前均经B超、CT等检查证实,手术后病理确诊。分别于手术前1天晨7时、手术开始后1小时、手术后第1天及手术后第2天晨7时抽取肘静脉血,应用放免法测定血清T_3、T_4、TSH、皮质醇(cortisol COR)、胰岛素(insulinINS)、胰高血糖素(glucogan GLU)的水平。实验结果应用SPSS11.0软件分析,采用重复测量数据的方差分析,以P＜0.05为有统计学意义。计量资料用(?)±s表示。
结果
两组手术前各项内分泌激素差异无显著(P＞0.05)。与术前比较,手术开始后1h、术后1d、2d各项激素水平均有所下降,两组间各项激素变化有同步性;手术后两组间比较,后腹腔镜组手术后各项激素的改变均小于开放手术组,但除术后第一天的T_3浓度0组明显低于RL组外(P=0.021),其余各时间点T_3、T_4、TSH、皮质醇、胰岛素(INS)、胰高血糖素(GLU)的浓度在两组间无统计学差异(P＞0.05)。
结论
本研究认为:①后腹腔镜手术和开放手术均对患者神经内分泌激素改变产生一定的影响。②后腹腔镜手术比开放手术对皮质醇的影响相对较小,但差异不大,说明两者对机体的创伤反应强度相当。③后腹腔镜手术比开放手术在胰岛功能的改变和应激反应程度上基本一致。④后腹腔镜手术对甲状腺应激反应影响较开放手术小。⑤与开放手术相比较,后腹腔镜手术的“微创”,不仅表现在切口微小,还表现在后腹腔镜组手术后各项内分泌激素的改变均小于开放手术组,有利于维护机体内环境的稳定。
Objective:To investigate the effects of retroperitoneal laparoscopic and conventional operation on neuroendocrine hormone of patients.
Methods:32 cases were divided into two groups according to the operative way: RL group received retroperitoneal laparoscopic operation(n=20) and O group underwent conventional operation(n=12).Blood samples were taken from vein preoperatively,at the 1 hour after operation,on the 1st day and 2nd day postoperatively.Serum cortisol(COR),insulin(INS),glucagon(GLU),T_3,T_4 and TSH concentrations were measured.The experimental data were analyzed by using a statistical softwere system SPSSI1.0.
Result:There was no significant difference between the two group in levels of T_3,T_4,TSH,INS,COR and GLU preoperatively(P＞0.05).Compared with the preoperative period,the levels of each hormone were decreased at every time points during or after operation in both groups,and the changes of each hormone in RL group were less than those of the O group.There was no significant difference between the two group in levels of T_4,TSH,INS,COR and GLU,but the levels of T_3 in O group was significantly lower than that in RL group on the 1st postoperative day(P＜0.05).
Conclusions:Urological retroperitoneal laparoscopic operation and conventional operation produce some effects on neuroendocrine hormone of the patients: Compared with the conventional operation,uroiogicai retroperitoneal laparoscopic operation produce less effects of 3,3',5-triiodothyronine on the patients,the difference was significant:and less effects of cortisol,T_4,TSH,INS and GLU,but the difference was not significant.Retroperitoneal laparoscopic operation induces a shorter stress response on patients.
引文
1.Cortesi N,Ferrari P,Zambarda E,et al.Diagnosis of bilateral abdominal cryptorchidism by laparoscopy[J].Endoscopy,1976,8(1):33-34.
2.Clayman RV,Kavoussi LR,Soper NJ,et al.Laparoscopic nephrectomy:initial case report[J].J Urol,1991,146(2):278-282.
3.Gaur DD.Laparoscopic operative retroperitonenscopy:Use of a new device[J].Urol,1992,148:1137-1139.
4.Nakada S Y,Moon T D,Gist M,et al.Use of the pneumosleeve as an adjunct in laparoscopic nephrectomy[J].Urology.1997,49(4:):612-613.
5.Gill IS.Needlescopic urology:current status[J].Urol Clin north Am,2001,28(1):71-83.
6.Guillonneau B,Cappele O,Martinez JB,et al.Robotic assisted,laparoscopic pelvic lymph node dissection in human[J].J Urol,2001,165(4):1078-1081.
7.Rassweiler J,Binder J,Frede T.Robotic and telesurgery:will they change our future[J]? Curr Opin Urol,2001,11(3):309-320.
8.Ho Hs,Saunders CJ,Gunther RA,et al.Effects of hemodyna during laparoscopy:CO2 absorption or intraabdominal ressure? J Surg Res,1995,59:497-503.
9.McDermott JP,Regan MC,Page R,et al.Cardiorespiratory effects of laparoscopy with and without gas insufflation.Arch Surg,1995,130:984-988.
10.张红艳,赵黎丽,王俊晖。腹膜后腹腔镜手术对全麻患者呼吸及循环的影响。腹腔镜外科杂志,2007,12(5):441-442。
11.Novitsky YW,Litwin DE,Callery MP.The net immunologic advantage of laparoscopic surgery.Surg Endosc,2004,18:1411-1419.
12.于泳浩,丘宇杰,王国林。后腹腔镜肾上腺手术对Yh1/Th2细胞平衡的影响.中国内镜杂志,2002,8(8):8-15
13.徐迎新,孟宪钧,黄志强。外科微创化研究进展。中华实验外科杂志。2002, 19:293
14.谭基明.外科病理生理学[M].北京:人民卫生出版社,1998:371-372.
15 徐华,王保国。手术应激反应研究进展。《国外医学》麻醉学与复苏分册。2003,24(5):278-280
16.All Uzunkoy,All Coskun O,Faruk AKlncl,et al.Systemic Stress Responses after Laparoscopic or Open Heria Repair.Eur J Surg,2000,166:167-170.
17.Marcovich R,Williams AL,Seifman BD,et al.A canine model to assess the biochemical stress response to laparoscopic and open surgery.J Endourol,2001,15:1005-1008
18.陈丽平,杨进琼,卢少红,等。妇科腹腔镜手术与开腹手术对心机酶谱及神经内分泌激素的影响。中国妇幼保健杂志,2005,20(16):2053-2055.
19.Landman J,Olweny E,Sundaram CP,et al.Prospective comparison of the immunological and stress response following laparoscopic and open surgery for localized renal cell carcinoma.J urol,2004,171:1456-1460.
20.穆娅玲,张宏。硬膜外麻醉与全身麻醉对妇科腹腔镜手术患者应激反应的影响。解放军医学杂志,2007,32(5):527-528.
21.Legakis IN,Golematis BC,Dourakis N,et al.Low T3 syndrome with asynchronous changes of TT_3 and rT3 values in laparoscopic.Chececyslectamy Endocr Res,1998,24(2):205-213.
1.Ksrayiannahis AJ,Makri G G,Mantzioka A,et al.Systemic stress response after laparoscopic or open cholecystectomy:a randomized trial.Br J Surg,1997,84:467-471.
2.Marana E,Scambia G,Maussier ML,et al.Neuroendocrine stress response in patients undergoing benign ovrian cyst surgery by laparoscopy,minilaparotomy,and laparotomy.J Am Assoc Gynecol Laparosc,2003,10(2):159-165.
3.Landman J,Olweny E,Sudaram CP,et al.Prospective comparison of the immunological and stress response following iaparoscopic and open surgery for localized renal cell carcinoma.J Urol,2004,171(4):1456-1460
4.All Uzunkoy,Ali Coskun O,Faruk AKlncl,et al.Systemic Stress Responses after Laparoscopic or Open Heria Repair.Eur J Surg,2000,166:167-470
5.Tsukamoto K,Tagi Y,Nakazawa T,et al.Gastroprokinetic effect and mechanism of SK-896,A new motilin analogue,during the interdigestive period in conscious dogs.Pharmacology,2001,63(2):95-102.
6.Gleich LL,Ryzenman J,Gluckman JL,et al.Recurrent advanced(T3or T4) head and neck squamous cell carcinoma is salvage possible? Arch Otolaryngol Head Neck Surg,2004,130(1):35-38
7.Berendes E,Schmidt C,Van Aken H,et al.A-type and B-type natriuretic peptides in cardiac surgical procedure.Anesth Analg,2004,98(1):11-19
8.Joris J Cigarini I,Legrand M,et al.Metabolic and respiratory changes after cholecystectomy performed via laparotomyor laparoscopy.Br J Anaesth,1992.69(4):341-345
9.Hammanguist F.Decrease in muscle glutamine,ribosomes and the nitrogen losses are similar after laparoscopic compared with open cholecystectomy during the immediate postoperative period.Surgery,1996,119:417
10.邱志刚,张建立,王洪友.腹腔镜直肠癌根治术围手术期对机体应激＼能量代谢及内脏蛋白的影响。中国微创外科杂志,2007,7(1):57-60
1.韩见知,Ralph V Clayman.正确选择输尿管结石的治疗方法[J].临床泌尿外科杂志,2003,18(9):569-570.
2.孙西钊.影响冲击波碎石疗效的因素及对策[J].临床泌尿外科杂志,2005,20(9):513-516.
3.Singal R K,Denstedt J D.Contemporary management of ureteral stones [J].Urol clin N Am,1997,24:59-62.
4.曾国华,李逊,吴开俊,等.微创经皮肾镜取石术治疗输尿管上段结石[J].中华泌尿外科杂志,2003,24(10):671-672.
5.Hemal A k,Goel A,Goel R.Minimally invasive retroperitoneoscopic ureterolithotomy[J].J Urol,2003,169(2):480-482.
6.苏红,吴兵,亓林,等.腔内钬激光碎石术与开放手术治疗复杂性输尿管结石的疗效比较[J].安徽医科大学学报,2007,42(3):317-319
1.石明,韩平,魏强,等。先天性马蹄肾临床分析(附21例报告)。华西医学,2005,20:322
2.Fletcher E W,kettlewell M G.Antegrade pyelography in a horseshoe kidney.Am J Roentgenol,1973,119:720
3.Lobe TE,Martin EW,Cooperman M,et al.Abdominal aortic surgery in the presence of a horseshoe kidney.J.Ann Surg,1978,188:71-78.
2.Clayman RV,Kavoussi LR,Soper NJ,et al.Laparoscopic nephrectomy:initial case report[J].J Urol,1991,146(2):278-282.
3.Gaur DD.Laparoscopic operative retroperitonenscopy:Use of a new device[J].Urol,1992,148:1137-1139.
4.Nakada S Y,Moon T D,Gist M,et al.Use of the pneumosleeve as an adjunct in laparoscopic nephrectomy[J].Urology.1997,49(4:):612-613.
5.Gill IS.Needlescopic urology:current status[J].Urol Clin north Am,2001,28(1):71-83.
6.Guillonneau B,Cappele O,Martinez JB,et al.Robotic assisted,laparoscopic pelvic lymph node dissection in human[J].J Urol,2001,165(4):1078-1081.
7.Rassweiler J,Binder J,Frede T.Robotic and telesurgery:will they change our future[J]? Curr Opin Urol,2001,11(3):309-320.
8.Ho Hs,Saunders CJ,Gunther RA,et al.Effects of hemodyna during laparoscopy:CO2 absorption or intraabdominal ressure? J Surg Res,1995,59:497-503.
9.McDermott JP,Regan MC,Page R,et al.Cardiorespiratory effects of laparoscopy with and without gas insufflation.Arch Surg,1995,130:984-988.
10.张红艳,赵黎丽,王俊晖。腹膜后腹腔镜手术对全麻患者呼吸及循环的影响。腹腔镜外科杂志,2007,12(5):441-442。
11.Novitsky YW,Litwin DE,Callery MP.The net immunologic advantage of laparoscopic surgery.Surg Endosc,2004,18:1411-1419.
12.于泳浩,丘宇杰,王国林。后腹腔镜肾上腺手术对Yh1/Th2细胞平衡的影响.中国内镜杂志,2002,8(8):8-15
13.徐迎新,孟宪钧,黄志强。外科微创化研究进展。中华实验外科杂志。2002, 19:293
14.谭基明.外科病理生理学[M].北京:人民卫生出版社,1998:371-372.
15 徐华,王保国。手术应激反应研究进展。《国外医学》麻醉学与复苏分册。2003,24(5):278-280
16.All Uzunkoy,All Coskun O,Faruk AKlncl,et al.Systemic Stress Responses after Laparoscopic or Open Heria Repair.Eur J Surg,2000,166:167-170.
17.Marcovich R,Williams AL,Seifman BD,et al.A canine model to assess the biochemical stress response to laparoscopic and open surgery.J Endourol,2001,15:1005-1008
18.陈丽平,杨进琼,卢少红,等。妇科腹腔镜手术与开腹手术对心机酶谱及神经内分泌激素的影响。中国妇幼保健杂志,2005,20(16):2053-2055.
19.Landman J,Olweny E,Sundaram CP,et al.Prospective comparison of the immunological and stress response following laparoscopic and open surgery for localized renal cell carcinoma.J urol,2004,171:1456-1460.
20.穆娅玲,张宏。硬膜外麻醉与全身麻醉对妇科腹腔镜手术患者应激反应的影响。解放军医学杂志,2007,32(5):527-528.
21.Legakis IN,Golematis BC,Dourakis N,et al.Low T3 syndrome with asynchronous changes of TT_3 and rT3 values in laparoscopic.Chececyslectamy Endocr Res,1998,24(2):205-213.
1.Ksrayiannahis AJ,Makri G G,Mantzioka A,et al.Systemic stress response after laparoscopic or open cholecystectomy:a randomized trial.Br J Surg,1997,84:467-471.
2.Marana E,Scambia G,Maussier ML,et al.Neuroendocrine stress response in patients undergoing benign ovrian cyst surgery by laparoscopy,minilaparotomy,and laparotomy.J Am Assoc Gynecol Laparosc,2003,10(2):159-165.
3.Landman J,Olweny E,Sudaram CP,et al.Prospective comparison of the immunological and stress response following iaparoscopic and open surgery for localized renal cell carcinoma.J Urol,2004,171(4):1456-1460
4.All Uzunkoy,Ali Coskun O,Faruk AKlncl,et al.Systemic Stress Responses after Laparoscopic or Open Heria Repair.Eur J Surg,2000,166:167-470
5.Tsukamoto K,Tagi Y,Nakazawa T,et al.Gastroprokinetic effect and mechanism of SK-896,A new motilin analogue,during the interdigestive period in conscious dogs.Pharmacology,2001,63(2):95-102.
6.Gleich LL,Ryzenman J,Gluckman JL,et al.Recurrent advanced(T3or T4) head and neck squamous cell carcinoma is salvage possible? Arch Otolaryngol Head Neck Surg,2004,130(1):35-38
7.Berendes E,Schmidt C,Van Aken H,et al.A-type and B-type natriuretic peptides in cardiac surgical procedure.Anesth Analg,2004,98(1):11-19
8.Joris J Cigarini I,Legrand M,et al.Metabolic and respiratory changes after cholecystectomy performed via laparotomyor laparoscopy.Br J Anaesth,1992.69(4):341-345
9.Hammanguist F.Decrease in muscle glutamine,ribosomes and the nitrogen losses are similar after laparoscopic compared with open cholecystectomy during the immediate postoperative period.Surgery,1996,119:417
10.邱志刚,张建立,王洪友.腹腔镜直肠癌根治术围手术期对机体应激＼能量代谢及内脏蛋白的影响。中国微创外科杂志,2007,7(1):57-60
1.韩见知,Ralph V Clayman.正确选择输尿管结石的治疗方法[J].临床泌尿外科杂志,2003,18(9):569-570.
2.孙西钊.影响冲击波碎石疗效的因素及对策[J].临床泌尿外科杂志,2005,20(9):513-516.
3.Singal R K,Denstedt J D.Contemporary management of ureteral stones [J].Urol clin N Am,1997,24:59-62.
4.曾国华,李逊,吴开俊,等.微创经皮肾镜取石术治疗输尿管上段结石[J].中华泌尿外科杂志,2003,24(10):671-672.
5.Hemal A k,Goel A,Goel R.Minimally invasive retroperitoneoscopic ureterolithotomy[J].J Urol,2003,169(2):480-482.
6.苏红,吴兵,亓林,等.腔内钬激光碎石术与开放手术治疗复杂性输尿管结石的疗效比较[J].安徽医科大学学报,2007,42(3):317-319
1.石明,韩平,魏强,等。先天性马蹄肾临床分析(附21例报告)。华西医学,2005,20:322
2.Fletcher E W,kettlewell M G.Antegrade pyelography in a horseshoe kidney.Am J Roentgenol,1973,119:720
3.Lobe TE,Martin EW,Cooperman M,et al.Abdominal aortic surgery in the presence of a horseshoe kidney.J.Ann Surg,1978,188:71-78.