阴式与腹式全子宫切除对体液免疫功能的影响

Comparative study on the influence of vaginal and abdominal hysterectomy on the humoral immune function

目的探讨阴式和腹式全子宫切除手术对于机体体液免疫功能的影响。方法 120例全子宫切除手术患者阴式组66例,腹式组54例,分别采集患者术前1天、术后第1天及术后第3天的外周静脉血标本,测定免疫球蛋白IgG、IgM、IgA,补体C3、C4,以及术后排气时间、住院时间等指标,比较两组之间的差异。结果两组患者手术时间、麻醉时间、术中出血量无显著性差异(t值分别为0.719、0.704、0.640,均P>0.05)。阴式组住院时间、术后排气时间短于腹式组(t值分别为2.733、14.698,均P<0.05)。两组患者术后第1天、术后第3天与术前1天相比,血液IgM、IgA、C3、C4水平均无显著性差异(P>0.05)。阴式组患者术后第1天、术后第3天血液IgG水平较术前1天降低(P<0.05),而腹式组血液IgG水平虽降低,但无显著性差异(P>0.05)。结论阴式与腹式手术方式对机体体液免疫的影响均比较小,阴式手术虽较腹式手术存在切口隐蔽等优点,但其对体液免疫功能影响方面是否明显优于腹式手术则还需进一步的深入研究。

Objective To explore the influence of vaginal and abdominal hysterectomy on humoral immune function. Methods Totally 120 cases of hysterectomy were divided into vaginal hysterectomy group （ n = 66 ） and abdominal hysterectomy group （ n = 54 ）. Peripheral venous blood samples were collected from the patients at 1 day before operation, 1 day after operation and 3 day after operation to detect IgG, IgM, IgA, C3 and C4 and make comparison in postoperative exhaust time and hospitalization stay between two groups. Results There was no significant difference in operation time, anesthesia time and intraoperatve blood loss （t value was 0. 719, 0. 704 and 0. 640, respectively, all P 〉 0.05 ）. But the hospitalization stay and postoperative exhaust time in vaginal hysterectomy group were significantly shorter than abdominal hysterectomy group （ t value was 2. 733 and 14. 698, respectively, both P 〈 0. 05 ）. The level of lgM, lgA, C3 and C4 at 1 day and 3 day after operation were not significantly different from that at 1 day before operation in two groups （ P 〉 0.05 ）. The level of IgG in vaginal hysterectomy group at 1 day and 3 day after operation was significantly lower than that at 1 day before operation （ P 〈 0.05 ）, but the decrease in abdominal hysterectomy group was not significant （ P 〉 O. 05 ）. Conclusion The influence of vaginal and abdominal operation on humoral immunity is slight. Although vaginal hysterectomy has the advantage of veiled incision, whether the influence of vaginal hysterectomy is superior to that of abdominal hysterectomy still needs further researches.