阴式与腹式全子宫切除术机体应激反应的比较

Comparison of the Stress Responses to Transvaginal and Transabdominal Hysterectomy

目的比较经阴道子宫切除术(transvaginal hysterectomy,TVH)与开腹子宫切除术(transabdominal hysterectomy,TAH)的机体应激反应和术后恢复情况。方法选择我院2009年7月～2010年12月因子宫良性病变拟行全子宫切除术110例,根据患者意愿分为2组,每组55例,分别施行TVH和TAH。分别于术前、术后第1天、术后第2天检测患者外周血血糖、白细胞总数、皮质醇、C-反应蛋白(C-reactive protein,CRP)及白细胞介素6(IL-6)水平,比较2组上述指标和手术时间、术中出血量、术后病率、术后排气时间的差异。结果 TVH组术后第1、2天白细胞计数分别为(6.9±2.2)×109/L和(7.2±2.0)×109/L,明显低于TAH组术后第1、2天(8.1±2.5)×109/L和(8.5±2.7)×109/L(t=2.673,P=0.009;t=2.869,P=0.005);TVH组术后第1、2天IL-6分别为(35.2±6.7)mg/L和(22.7±5.1)mg/L,明显低于TAH组术后第1、2天(63.1±11.4)mg/L和(46.3±9.5)mg/L(t=15.648,P=0.000;t=16.232,P=0.000);TVH组术后第1、2天CRP分别为(46.6±8.7)mg/L和(24.5±3.9)mg/L,显著低于TAH术后第1、2天(97.3±13.2)mg/L和(43.7±7.3)mg/L(t=23.784,P=0.000;t=17.023,P=0.000);TVH组总皮质醇术后第1、2天分别为(112.4±11.2)μg/L和(167.2±18.5)μg/L,明显低于TAH组术后1、2天(126.5±12.1)μg/L和(193.1±21.3)μg/L(t=6.342,P=0.000;t=6.808,P=0.000);2组血糖术后第1、2天差异无显著性(t=0.494,P=0.622;t=0.499,P=0.619)。TVH组术中出血量(89±29)ml,术后排气时间(28±4)h,术后病率5例(9.1%),均与TAH组(125±37)ml,(49±7)h,术后病率20例(36.4%)有显著性差异(P<0.05),2组手术时间无显著性差异[(72.5±15.9)min vs.(77.3±13.1)min,t=1.728,P=0.087]。结论 TVH术后患者机体应激反应小,对病人创伤小,恢复快。

Objective To compare the stress response and postoperative recovery between patients undergone vaginal and transabdominal hysterectomy（TVH） and transabdominal hysterectomy（TAH）. Methods From July 2009 to December 2010,a total of 110 cases scheduled for total hysterectomy for benign lesions were divided into TVH and TAH groups（55 cases in each） based on the patients＇ willingness.Levels of peripheral blood glucose,WBC count,cortisol,IL-6,and CRP were measured preoperatively,and 1 and 2 days after the operation.The measurements of the two groups,as well as operation time,intraoperative blood loss,postoperative morbidity and recovery time of gastrointestinal function were compared between the two groups.Results On both the 1st and 2nd day after the operation,TVH group showed significantly lower levels of WBC count [（6.9±2.2）×109/L and（7.2±2.0）×109/L vs.（8.1±2.5）×109/L and（8.5±2.7）×109/L;t=2.673,P=0.009 and t=2.869,P=0.005],IL-6 [（35.2±6.7） mg/L and（22.7±5.1） mg/L vs.（63.1±11.4） mg/L and（46.3±9.5） mg/L;t=15.648,P=0.000 and t=16.232,P=0.000],CRP [（46.6±8.7） mg/L and（24.5±3.9） mg/L vs.（97.3±13.2） mg/L and（43.7±7.3） mg/L;t=23.784,P=0.000 and t=17.023,P=0.000],and cortisol [（112.4±11.2） μg/L and（167.2±18.5） μg/L vs.（126.5±12.1） μg/L and（193.1±21.3） μg/L;t=6.342,P=0.000 and t=6.808,P=0.000] than TAH group;whereas,no significant difference existed in the level of blood Glu between the two groups（t=0.494,P=0.622 and t=0.499,P=0.619）.In addition,TVH group showed significantly less intraoperative blood loss,shorter recovery time of gastrointestinal function,and lower postoperative morbidity than TAH group [（89±29） ml vs.（125±37） ml,（28±4） h vs.（49±7） h,and 5 cases（9.1%） vs.20 cases（36.4%）,all P0.05].No significant difference was detected between the two groups in operation time [（72.5±15.9） min vs.（77.3±13.1） min,t=1.728,P=0.087].Conclusions Compared to TAH,TVH results in less stress response,less trauma and quicker postoperative recovery.