Effect Of Laparoscopic Renal Surgery On Immune Function And Stress Response

Part â… Clinical comparative study of laparoscopic renal surgery and open renal surgery[Objective]To compared safety and short-term outcomes of laparoscopic renal surgery and open renal surgery in patients with renal cell carcinomas.[Methods]47 patients with renal cell carcinomas were divided into laparoscopic renal surgery group (LRS,n=24) and open renal surgery group (ORS,n=23) from December 2005 to March 2007. The patient age, gender, body mass index, right: left ratio, size of tumor, TNM, ASA classification and operation were equivalent between two groups. LRS included laparoscopic radical nephrectomy (n=18) and laparoscopic partial nephrectomy (n=6) cases. While ORS included open radical nephrectomy (n=19) and open partialnephrectomy (n=4) cases. All patients were made a diagnosis of renal cell carcinoma by B ultrasonic inspection, IVP, CT and MRI. And previous operative history were equivalent between groups. The operation time, intraoperative blood loss, postoperative pain degree, consumption of patient controlled analgesia, BP, P, T, SaPO₂, volume of drain, recovery of out-of-bed ambulation and postoperative hospital stay were compared between two groups.[Results]In LRS, beside the operation time(P>0 05), intraoperative blood loss, postoperative pain degree, consumption of patient controlled analgesia, volume of drain, recovery of out-of-bed ambulation and postoperative hospital stay were all better than those in ORS (P<0 05). Postoperative BP, P, SaPO₂ were stable in both groups. Orem's self-care deficit nursing theory met one's constant requirements for care that regulates life processes, maintainshe integrity of human structure and promotes well-being. [Conclusion]The results demonstrated decreased blood loss, decreased postoperative analgesic requirements, shorter hospital stay from the laparoscopic procedures. Laparoscopy is a safe, effective, minimally invasive alternative surgical technique. It would be useful to implement Orem's self-care deficit nursing theory into nursing patients who underwent renal surgery.Part â…¡Systemic immune response to laparoscopic renal surgery[Objective]To compared the alteration of immue function following laparoscopic and open renal surgery in patients with renal cell carcinomas.[Methods]47 patients with renal cell carcinomas were divided into laparoscopic renal surgery group (LRS,n=24) and open renal surgery group (ORS,n=23). CD3, CD4, CD8, CD19, natural killer cells (NK cells) in peripheral venous blood were assayed at time before operation, and 1 hour, 1 day, 3 days, 5 days after operation.[Results]There was no difference in all the parameters between the two groups before operation. CD3 at 1 hour, 1 day, 3 days, 5 days after operation in two groups were significantly lower than those before operation, and CD3 at 1 hour after operation in LRS were significantly higher than those in ORS. CD4 at 1 hour, 1 day, 3 days after operation in LRS were significantly lower than those before operation, CD4 at 1 hour, 3 days after operation in ORS were significantly lower than those before operation, and CD4 at 1 hour after operation in LRS were significantly higher than those in ORS. There was no statistically difference in CD8 in LRS before and after operation. CD8 at 1 hour, 1 day, 3 days after operation in ORS were significantly lower than those before operation. CD8 at 1 hour after operation in LRS were significantly higher than those in ORS. There was no statistically difference in CD4/CD8 before and after operation. NK cells at 1 hour, 1 day, 3 days after operation in LRS were significantly higher than those before operation, NK cells at 1 day, 3 days after operation in ORS were significantly higher than those before operation, there was no statistically difference between the two groups. CD19 at 1 hour after operation in LRS were significantly lower than those before operation, CD19 at 1 hour, 1 day after operation in ORS were significantly lower than those before operation, there was no statistically difference between the two groups.[Conclusion]Both laparoscopic and open renal surgery cause a certain degree of immune suppression which is reversible. Laparoscopic renal surgery has less effect on immune function than traditional open surgery.Part â…¢Stress response to laparoscopic renal surgery[Objective]To compared the surgical stress after laparoscopic and open renal surgery in patients with renal cell carcinomas.[Methods]47 patients with renal cell carcinomas were divided into laparoscopic renal surgery group (LNS, n=24) and open renal surgery group (ORS, n=23). ACTH and cortisol in peripheral venous blood were assayed at time before operation, and 1 hour, 1 day, 3 days, 5 days after operation.[Results]There was no difference in all the parameters between the two groups before operation. ACTH at 1 hour, 1 day after operation in two groups were significantly higher than those before operation. Cortisol at 1 hour, 1 day after operation in LRS were significantly higher than those before operation, and cortisol at 1 hour, 1 day, 3 days after operation in ORS were significantly higher than those before operation. ACTH and cortisol at 1 hour after operation in ORS was significantly higher than those in LRS.[Conclusion]Laparoscopic and open renal surgery cause a certain degree of surgical stress, and that laparoscopic surgery is markedly less stressful than open surgery in the early time after operation.