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目的：探讨后腹腔镜肾脏手术对机体应激的影响。方法：选取2011 年1 月~2013 年12 月本院泌尿外科住院拟行肾脏手术的患者69 例，分为后腹腔镜肾脏手术组（39 例）与开放性肾脏手术组（30 例），分别检测两组患者术前、术后1 h、术后24 h、术后72 h 术后120 h体内促肾上腺皮质激素（ACTH）、皮质醇（COR）、C 反应蛋白（CRP）的含量，进行对比分析。结果：后腹腔镜肾脏手术组、开放性肾脏手术组两组ACTH 和COR 水平差异均有统计学意义（F 分组＝107.286，P＝0.000；F 分组＝9.092，P＝0.004）；各个时间点的ACTH 和COR 差异也有统计学意义（F 时间＝221.454，P＝0.000；F 时间＝94.257，P＝0.000），术后1 h两组的ACTH 和COR 均明显增高，术后24 h、术后72 h及术后120 h两组的ACTH 和COR均明显降低，后腹腔镜肾脏手术组术后72 h ACTH和COR 降至术前水平，开放性肾脏手术组术后120 h ACTH 和COR 降至术前水平；后腹腔镜肾脏手术组不同时间点ACTH 和COR 的变化幅度小于开放性肾脏手术组（F 交互＝36.446，P＝0.000；F 交互＝7.271，P＝0.000）。CRP比较，两组差异也有统计学意义（F 分组＝ 41.526，P＝0.000）；各个时间点的CRP差异也有统计学意义（F 时间＝405.201，P＝0.000），术后1 h、术后24 h、术后72 h CRP 持续升高，术后120 h CRP 明显降低；后腹腔镜肾脏手术组不同时间点COR 升高幅度小于开放性肾脏手术组（F 交互＝14.111，P＝ 0.000）。结论：后腹腔镜肾脏手术对机体应激反应的影响程度小于开放性肾脏手术，能较大程度地维护机体神经系统及内分泌系统的稳定，更有利于机体的恢复。

英文摘要:

Objective:To study the influence of retroperitoneal laparoscopic operation on traumatic stress response.Methods:69 patients with renal surgery were selected from the department of urology in our hospital in January 2011 to December 2013, and divided into retroperitoneal laparoscopic renal surgery group (39 cases) and open renal surgery group (30 cases). The content of ACTH, COR and CRP in two groups was detected and comparatively analyzed before operation and 1 h, 24 h and 72 h, 120 h after operation.Results:The level of ACTH and COR was statistically significant between two groups (Fgroup＝107.286, P＝0.000; Fgroup＝9.092, P＝0.004); the level of ACTH and COR was statistically significant at all the time points (Ftime＝221.454, P＝0.000; Ftime＝94.257, P＝0.000), and the level of ACTH and COR of the two groups was significantly higher after 1 h of operation, and significantly decreased after 24 h, 72 h and 120 h, and the level of ACTH and COR was returned to the preoperative level after 72 h in laparoscopic group and after 120 h in open renal surgery group. The change of ACTH and COR in different time points was smaller in laparoscopic group than that of the open renal surgery group (Ftime*group＝36.446, P＝0.000; Ftime*group＝7.271, P＝0.000). The difference of CRP between the two groups was statistically significant (F group＝41.526, P＝0.000); and CRP were statistically significant at all the time points (F time＝405.201, P＝0.000), after 1h , 24 h and 72 h of operation, the level of CRP continued to increase in two groups, and the level of CRP was decreased after 120 h of operation, but the increase of COR in different time points was smaller in laparoscopic group than that of the open renal surgery group (F time*group＝14.111, P＝0.000).Conclusion:The effect of retroperitoneal laparoscopic renal surgery on stress response is less than that of open renal operation, and it can maintain the stability of the nervous systemand endocrine system, and is more conducive to the recovery of the body.

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