经阴道与腹腔镜下子宫肌瘤剔除术对子宫肌瘤患者的影响

Effect of transvaginal and laparoscopic myomectomy on patients with uterine fibroids

目的比较经阴道与腹腔镜下子宫肌瘤剔除术对子宫肌瘤的临床疗效及免疫功能影响。方法选取2014年1月—2016年7月收治的子宫肌瘤患者84例,随机分为经阴道组和腹腔镜组各42例,观察两组术中出血量、手术时间、肌瘤剔除数量和最大直径、胃功能恢复时间、肛门排气时间以及术后病率,在术前及术后1 d、3 d测定Ig G、Ig M、Ig A及CD3+、CD4+、CD8+水平,采用SPSS20.0软件对数据进行统计分析,计量资料组间比较采用t检验,计数资料采用χ2检验,以P<0.05为差异有统计学意义。结果经阴道组术中出血量、手术时间、术后胃功能恢复时间及肛门排气时间分别为(152.65±23.63)ml、(89.41±13.15)min、(1.62±0.44)h、(18.55±2.68)h,均低于腹腔镜组的(184.32±25.48)ml、(101.72±14.58)min、(1.81±0.32)h、(21.46±2.97)h,比较差异均有统计学意义(P<0.05);术后1 d两组Ig G、Ig M、Ig A及CD3+、CD4+、CD8+水平分别为均明显下降(P<0.05),腹腔镜组水平明显低于经阴道组(P<0.05),术后3 d经阴道组各项指标恢复至术前水平,腹腔镜组Ig G、CD4+、CD8+水平仍低于术前水平且低于经阴道组(P<0.05)。结论相比于腹腔镜手术,经阴道手术操作简便快速,术中出血量少,对胃肠道干扰小,对机体免疫功能抑制轻微,在同等条件下,若可以实施经阴道手术,建议优先选择。

Objective To compare the clinical efficacy of vaginal myomectomy（VM） and laparoscopic myomectomy（LM） on uterine fibroids. Methods A total of 84 patients with uterine leiomyoma from January 2014 to July 2016 were enrolled and randomly divided into VM group and LM group（42 patients in each group）. The intraoperative bleeding, operation time, number and maximum diameter of myoma removal, recovery time of stomach function, anal exhaust time and postoperative morbidity of the two groups were compared. The levels of IgG, IgM, IgA, CD3^＋, CD4^＋ and CD8^＋ were detected before and 1d, 3d after operation. Measurement data uses t test, count data uses χ^2 test. P〈0.05 is considered statistically significant. Result The intraoperative bleeding, operation time, recovery time of stomach function and anal exhaust time of VM group [（152.65±23.63）ml,（89.41±13.15）min,（1.62±0.44）h,（18.55±2.68）h]were significantly lower than those of LM group [（184.32±25.48）ml,（101.72±14.58）min,（1.81±0.32）h,（21.46±2.97）h]（P〈0.05）. The levels of Ig G, Ig M, Ig A, CD3^＋, CD4^＋ and CD8＋of two groups were significantly reduced 1 day after operation（P〈0.05）. Besides, levels of the above indexes of LM group were significantly lower than those of VM group（P〈0.05）. The levels of the above indexes of VM group returned to preoperative levels 3 days after operation. The levels of Ig G, CD4^＋ and CD8^＋ of LM group were still lower than preoperative levels and VM group 3 days after operation（P〈0.05）. Conclusion Compared with laparoscopic operation, vaginal operation is simpler and rapider, with less intraoperative bleeding, less interference to gastrointestinal tract and less immunosuppression. Under the same conditions, vaginal operation is recommended on basis of can be implemented.