| Objective:By comparing the efficacy,safety and influence on immune system of robot-assisted laparoscopic and conventional laparoscopic partial nephrectomy in the treatment of renal cancer,the advantages and disadvantages of the two in clinical application were further discussed to provide reference for the selection of clinical treatment methods.Methods:Clinical data of 98 patients with renal cancer admitted to the Department of Urology of our hospital from January 2019 to January2021 were retrospectively analyzed.They were divided into LPN group(n=39),RAPN group(n=59)according to different surgical methods.General sociological data(gender,age,BMI index,tumor location,RENAL score,tumor diameter,TNM stage and pathological type)of patients in the two groups were statistically analyzed.Perioperative related indicators(length of stay,hospitalization cost,operation time,intraoperative blood loss,heat ischemia time,postoperative drainage flow,drainage tube carrying time,gastrointestinal function recovery time)were analyzed.Preoperative and postoperative differences in Hgb,blood Scr,e GFR,humoral immunity(Ig G,Ig M,Ig A),cellular immunity(CD4+,CD8+,CD4+/CD8+),inflammatory factors(TNF-α,CRP,IL-6);Postoperative complications(urinary fistula,bleeding,intraoperative area bleeding infection,arteriovenous fistula)were analyzed.Results:There were no significant differences in age,gender,BMI index,affected side,tumor diameter,Renal score,TNM stage,pathological type and postoperative incision positive rate between the two groups(P>0.05).The operative time,intraoperative bleeding,heat ischemia time,hospitalization time,drainage tube carrying time and gastrointestinal function recovery time in RAPN goup were lower than those of LPN group,and the hospitalization cost was higher than that in LPN group,the difference was statistical significant(P<0.05).The expression of HGB,Scr and e GFR in the two groups were at the same level before operation,with no statistical significance(P>0.05).The expressions of HGB and e GFR were down-regulated and Scr were up-regulated after operation.The absolute values of HGB and e GFR down-regulated and Scr up-regulated in RAPN group were lower than those in LPN group,and the differences were statistically significant(P<0.05).Before surgery,there was no significant difference in the expression of inflammatory factors TNF-α,CRP,IL-6,humoral immune factors Ig G,Ig M,Ig A,and cellular immune factors CD4+,CD8+,CD4+/CD8+ between two groups(P>0.05).After surgery,the expressions of TNF-α,CRP and IL-6 were up-regulated,while the expressions of Ig G,Ig M,Ig A,CD4+,CD8+ and CD4+/CD8+ were down-regulated,and the expressions of RAPN group were slower than those of LPN group,the differences were statistically significant(P<0.05).There were no urinary fistula,delayed bleeding,venous fistula,acute renal failure,recurrence and metastasis after operation in the two groups.In LPN group,there were 32 cases of abscess and 1 case of exudation and fever in the operative area,and the complication rate was 7.69%.In RAPN group,there was 1 case of bleeding infection in the operative area,and the incidence of complications was 1.69,the difference was statistically significant(P<0.05).Conclusion:(1)Robot-assisted laparoscopy can reduce heat ischemia time,protect renal function and control perioperative operative time on the basis of achieving the same surgical effect as conventional laparoscopy.The amount of blood loss and gastrointestinal function can be recovered,the length of hospital stay can be shortened,the inflammatory reaction can be inhibited,the immune capacity of the body can be improved,and the probability of postoperative bleeding infection can be reduced ultimately,and the disease recovery can be promoted.(2)Robotic surgical system for partial nephrectomy has better safety and feasibility,and is expected to become the preferred surgical method for the treatment of renal tumor in the future. |
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