阴式与腹式全子宫切除术机体应激反应的比较

Stress Response of Vaginal Versus Abdominal Hysterectomy

目的比较阴式(VH)与腹式子宫切除术(AH)机体应激反应和术后恢复情况。方法将220例因良性原因拟行全子宫切除术患者随机分为阴式组和腹式组各110例。分别采用VH和AH二种术式手术。分别于术前、术后2h、1d检测两组患者的外周血血糖(Glu)、白细胞介素-6(IL-6)和C-反应蛋白(CRP)水平,并进行对比分析,同时比较两组患者的手术时间、术中出血量、肛门排气时间及术后住院时间。结果阴式组的术中出血量、肛门排气时间及术后住院时间明显少于腹式组,差异有统计学意义(均P<0.01,t=8.939,18.762,8.727),而手术时间两组间差异无统计学意义(P>0.05,t=1.922)。阴式组术后2h的血清IL-6水平明显低于腹式组,且术后1d的IL-6和CRP水平明显低于腹式组,差异有统计学意义(均P<0.01,t=41.459,16.711,24.281),余则两组间差异无统计学意义(均P>0.05)。结论VH术后应激反应比AH小,且术后恢复较好。

Objective To investigate the stress response and postoperative recovery state ofvaginal（VH） versus abdominalhysterectomy（AH）. Methods A total of 220 cases schedulced for total hysterectomy for benign disease were randomly divided into the VH and AH group,each consisting of 110 cases, receiving VH and AH respectively. Circulating blood glucose（Glu）, IL-6, and CRP levels were measured preoperative- ly,2h and 1 day after operation between both two groups,and the operative duration,intraoperative blood loss,time of anal gas passage and postoperative hospital stay were compared between both two groups. Results The intraoperative blood loss,time of anal gas passage and postoperative hospital stay were markedly less in the VH group than in the AH group,with significant differences between two groups,all P〈 0.01 （t = 8.939,18.762, and 8.727 respectively）, while the operative duration was not different, P 〉 0.05（ t = 1.922）. The serum IL-6 level was considerably lower 2h postopeartion in the VH group than in the AH group, and the levels of IL-6 and CRP 1 day after operation remained the same, with significant differences, all P 〈 0.01 （t = 41.459,16.711, and 24.281 respectively）. No significant differences were noted at the other point between two groups, all P 〉 0.05. Conclusion VH proves to have less stress response as compared to AH, with better postoperative recovery.