子宫肌瘤腹腔镜与开腹切除术围术期TNF-α、IL-6和IL-10的变化

The changes of tumor necrosis factor-α,interleukin-6 and interleukin-10 during perioperative period in cases receiving laparoscopic myomectomy and hysteromyomectomy

目的:探讨子宫肌瘤腹腔镜与开腹切除术围术期血清TNF-α、IL-6及IL-10的变化。方法:选择60例子宫肌瘤切除术患者随机平均分为两组,Ⅰ组行开腹子宫肌瘤切除术,Ⅱ组行腹腔镜下子宫肌瘤切除术;两种术式的手术时间均在100～120 min之内。于手术前1天、手术开始后90 min、术后第1天、术后第3天和第7天采集静脉血检测TNF-α、IL-6,IL-10水平。结果:①手术前1天:Ⅰ组和Ⅱ组TNF-α均明显高于正常值,而IL-6和IL-10均正常。②手术开始后90 min,Ⅰ组和Ⅱ组TNF-α、IL-6及IL-10均明显增高,与手术前1天、术后第1天、术后第3天和第7天比较有明显统计学差异。③术后第1天,Ⅰ组和Ⅱ组TNF-α、IL-6及IL-10仍维持较高水平,与手术前1天、术后第3天和第7天比较有明显统计学差异。④术后第3天,Ⅰ组TNF-α、IL-6及IL-10明显恢复,但仍高于正常,与术后第7天比较均有明显统计学差异,而Ⅱ组TNF-α、IL-6及IL-10明显降低并恢复正常,与术后第7天比较无统计学差异。⑤术后第7天,Ⅰ组和Ⅱ组TNF-α、IL-6及IL-10均恢复正常。结论:①手术创伤可引起炎性因子释放增加,抗炎性细胞因子分泌也随之增加。②子宫肌瘤腹腔镜切除术与开腹切除术围术期TNF-α、IL-6、IL-10均于手术结束前达高峰,但前者峰值较低,恢复更快,手术创伤更小。

Objective：To explore the changes of serum tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6） and interleukin-10（IL-10） in cases receiving laparoscopic myomectomy and hysteromyomectomy. Methods：60 cases with hysteromyoma were divided into two groups： group Ⅰ received hysteromyomectomy,while group Ⅱ received laparoscopic myomectomy.The operation times of the two groups were both within 100~120 minutes.The venous blood samples were Abstracted at one day before operation and 90 minutes,one day,three days,seven days after operation to detect the serum levels of TNF-α,IL-6 and IL-10. Results：At one day before operation： the serum levels of TNF-α in group Ⅰ and group Ⅱ were significantly higher than normal values,but the serum levels of IL-6 and IL-10 were normal.At 90 minutes after operation： the serum levels of TNF-α,IL-6 and IL-10 in group Ⅰ and group Ⅱ increased significantly,compared with those at one day before operation and one day,three days,seven days after operation,there was significant difference.At one day after operation： the serum levels of TNF-α,IL-6 and IL-10 in group Ⅰ and group Ⅱ maintained relatively high,compared with those at one day before operation and three days,seven days after operation,there was significant difference.At three days after operation： the serum levels of TNF-α,IL-6 and IL-10 in group Ⅰ recovered obviously,but they were still higher than normal values,compared with those at seven days after operation,there was significant difference;while the serum levels of TNF-α,IL-6 and IL-10 in group Ⅱ decreased significantly and returned to normal,compared with those at seven days after operation,there they were no significant difference.At seven days after operation： the serum levels of TNF-α,IL-6 and IL-10 in group Ⅰ and group Ⅱ returned to normal. Conclusion：Operational injury can induce the increase of inflammatory factors release,so the secretions of anti-inflammatory cytokines increase.The serum levels of TNF-α,IL-6 and IL-10 during perioperative period in cases receiving laparoscopic myomectomy and hysteromyomectomy peak at the end of operation,but the peak of the former is relatively low with shorter recovery time and fewer operational injury.