腹腔镜与剖腹子宫切除手术患者血清白细胞介素-6和C反应蛋白水平

DYNAMIC OBSERVATION OF INTERLEUKIN-6 AND C-REACTIVE PROTEIN FOLLOWING LAPAROSCOPIC HYSTERECTOMY AND ABDOMINAL HYSTERECTOMY IN PATIENTS

目的 :比较腹腔镜子宫切除术 (LH)与开腹子宫切除术 (AH)引起机体的损伤程度。方法 :选择 6 0例有子宫切除手术指征的患者 ,分为两组 ,分别行腹腔镜和剖腹子宫切除术各 30例。测术前、术后 2 4h指血白细胞(WBC)数、中性粒细胞比率 (NGR) ,ELISA双抗体夹心法及散射比浊法测术前、术后 2 4h和 48h静脉血清白细胞介素 - 6 (IL - 6 )和C -反应蛋白 (CRP)。并比较两组的手术时间、术中出血、术后镇痛用药率、术后静脉输液日、住院日和术后病率。结果 :AH组术后 2 4hWBC计数比术前明显增高 (P <0 .0 1) ,LH组升高不明显(P >0 .0 5 ) ;两组术后NGR均明显升高 (P <0 .0 5 ) ,但AH组升高的更多 (P <0 .0 1)。两组术后 2 4h、48h的血清IL - 6和CRP水平均明显高于术前 (P <0 .0 1) ,但AH组术后 2 4h、48h的血清IL - 6和CRP浓度均显著高于LH组 (P <0 .0 1)。与剖腹手术组比 ,腹腔镜手术出血少 ,用药少 ,术后病率低 ,住院日短。结论 :腹腔镜手术组IL - 6和C反应蛋白反应水平较剖腹手术组低 ,与组织创伤小、出血少有关。

Objective:To observe the dynamic changes of interleukin-6(IL-6) and C-reactive protein(CRP) before and after laparoscopic hysterectomy(LH) and abdominal hysterectomy (AH) in patients.Methods:Sixty hysterectomy patients were randomized into LH and AH groups with 30 in each group.The white blood cell(WBC) and neutrophil granulocte rate(NGR) in finger blood samples,IL-6 and CRP in serum from venous blood at 24 hour before and at 24 and 48 hours(except WBC) after operation were measured.Results:It was demonstrated that WBC count increased significantly in AH group but not in LH group after operation.After operation, NGR were raised markedly in both groups( P <0.05) but with higher rate in AH group( P <0.01).Both contents of IL-6 and CRP increased markedly at 24h and 48h postoperatively in both LH and AH patients,but with much higher concentrations in AH group ( P <0.01).Compared with AH patients,LH ones had less operation bleeding,lower febrile morbidity rate,less drug consumption and shorter hospital stay.Conclusions:LH patients had less intense stress responses than AH ones postoperatively because of less injury and bleeding.