腹腔镜与开腹子宫肌瘤剔除术患者围手术期相关变化的研究

Study on perioperative situations of patients with laparoscopic or open resection of uterine fibroids

目的探讨腹腔镜子宫肌瘤剔除术与开腹子宫肌瘤剔除术患者围手术期氧化应激状态、炎性状态及免疫状态变化。方法将60例子宫肌瘤剔除术患者按照手术方式分为两组,其中30例为对照组,行开腹子宫肌瘤剔除术;30例为研究组,行腹腔镜子宫肌瘤剔除术,对两组患者围手术期氧化应激指标、炎性因子及免疫功能指标变化情况进行分析。结果两组患者术后血清丙二醛(MDA)呈现先升高后降低的变化规律,超氧化物歧化酶(SOD)、还原型谷胱甘肽过氧化物酶(GSH-Px)呈现先降低后升高的变化规律,观察组术后1d、3d、7d时氧化应激状态各项指标与对照组比较差异有统计学意义(MDA:t值分别为6.44、6.81、7.61,均P<0.05;SOD:t值分别为6.30、7.82、6.83,均P<0.05;GSH-Px:t值分别为7.72、6.89、6.32,均P<0.05)。两组患者术后炎性状态指标白细胞介素-1β(IL-1β)、C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)均呈现先升高后降低的变化规律,且研究组术后1d、3d、7d时各项指标均明显低于对照组(IL-1β:t值分别为6.30、6.64、7.95,均P<0.05;CRP:t值分别为6.52、7.77、6.67,均P<0.05;TNF.α:t值分别为7.48、6.65、6.67,均P<0.05)。两组患者术后免疫状态指标CD3^+、CD4^+、CD8^+均呈现先降低后升高的变化规律,且术后7d时均可基本恢复术前水平,研究组术后1d、3d时各项指标均明显高于对照组(CD3^+:t分别为6.86、7.54,均P<0.05;CD4^+:t值分别为7.45、6.60,均P<0.05;CD8^+:t值分别为7.36、6.69,均P<0.05)。结论腹腔镜手术用于子宫肌瘤剔除术时对患者围手术期氧化应激状态、炎性状态及免疫状态的影响较小,且能快速恢复至术前水平,有利于患者的术后恢复。

Objective To explore the oxidative stress state, inflammatory state and immune state in patients with laparoscopic uterine fibroids resection or open resection of uterine fibroids. Methods Sixty cases of uterine fibroids were divided into two groups according to operation mode, control group （30 cases） treated with open resection of uterine fibroids and observation group （30 cases） treated with laparoscopie uterine fibroids resection. The oxidative stress state, inflammatory state and immune state of two groups were compared. Results After surgery MDA in both groups showed the change of rising first and then decrease, while SOD and GSH-Px showed the change of decline first and then rising. One day, 3d and 7d after surgery, the differences in the indicators of oxidative stress state between two groups were significant （ tMog value was 6.44, 6.81 and 7.61, tsoD value was 6.30, 7.82 and 6.83, TGSH-Px value was 7.72, 6.89 and 6.32, respectively, all P 〈 0.05 ）. Postoperative inflammatory state indexes of IL-1β, CRP and TNF-α increased first and then declined in two groups, and those of the observation group at 1d, 3d and 7d after surgery were significantly lower than the control group （tIL-1β value was 6.30, 6.64 and 7.95, tCRP value was 6.52, 7.77 and 6.6, tTNF-α value was 7.48, 6.65 and 6.67, respectively, all P 〈 0.05 ）. The immune status indexes of CD3^＋ , CD4^＋ and CD8^＋ of two groups after surgery showed decrease first and then rising, and they could returned to preoperative levels 7d after surgery. The indexes of the observation group were significantly higher than those of the control group at 1d and 3d after surgery （tCD3＋ value was 6.86 and 7.54, tCD4＋ value was 7. 45 and 6.60, tCD8＋ value was 7. 36 and 6. 69, respectively, all P 〈 0.05 ）. Conclusion Laparoscopic resection of uterine fibroids has milder influence on perioperative oxidative stress, inflammatory state and immune status, and all indexes can quickly restore to preoperative levels, which is beneficial to recovery of patients.