宫腔镜联合腹腔镜子宫肌瘤剔除术对患者血清炎性因子及生活质量的影响

Effect of Hysteromyomectomy by Hysteroscopy Combined with Laparoscopic on Serum Inflammatory Factors and Quality of Life of Patients

目的:探讨宫腔镜联合腹腔镜子宫肌瘤剔除术对患者血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)及生活质量的影响。方法:124例2～5型子宫肌瘤患者,均分为开腹组和联合组,开腹组采用传统开腹子宫肌瘤切除术,联合组采用腹腔镜联合宫腔镜子宫肌瘤切除术;比较2组患者手术时间、肛门排气时间、住院时间、术中出血量、术后镇痛药物使用率、并发症发生率及术后1年的复发率;于手术前及术后第3天,采用SF-36量表评分评价2组生活质量,比较2组患者的血清CRP、IL-6、TNF-α及IL-8水平。结果:与开腹组比较,联合组手术时间、肛门排气时间、住院时间显著缩短,术中出血量、术后镇痛药物使用率及术后并发症发生率显著低于对照组(P <0. 05),术后随访1年两组患者子宫肌瘤复发率比较,差异无统计学意义(P>0. 05);手术前两组患者血清CRP、IL-6、TNF-α、IL-8水平及SF-36各维度评分比较,差异无统计学意义(P>0. 05);术后第3天,2组患者血清CRP、IL-6、TNF-α、IL-8水平及SF-36各维度评分显著高于手术前,开腹组血清CRP、IL-6、TNF-α、IL-8水平显著高于联合组、SF-36各维度评分显著低于联合组,差异有统计学意义(P <0. 05)。结论:宫腔镜联合腹腔镜治疗2～5型子宫肌瘤效果优于传统开腹子宫肌瘤切除术,且能提高患者生活质量。

Objective:To investigate the effect of hysteromyomectomy by hysteroscopy combined with laparoscopic on serum c-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor(TNF-alpha)and quality of life of patients.Methods:124patients with type2-5uterine fibroids admitted to our hospital from January 2014 to December 2016 were divided into the open group(62cases)and the combined group(62cases)according to the operative method.The open group was treated with laparotomy hysteromyomectomy,the other was treated with hysteromyomectomy by laparoscopy combined with hysteroscopy.The operation time,anal exhaust time,hospitalization time,intraoperative blood loss,use of postoperative analgesics,incidence of complications,recurrence rate;the levels of serum CRP,IL-6,TNF-a and other inflammatory factors were compared between the two groups.The quality of life was evaluated between the two groups by SF-36scale before surgery and3days after surgery.Results:The operation time,anal exhaust time and hospitalization time of the combined group were significantly shorter than those of the control group;the amount of bleeding during operation,the use rate of postoperative analgesics and the incidence of postoperative complications were lower than those of the control group(P<0.05),there was no significant difference in the recurrence rate of uterine fibroids between the two groups postoperative follow-up visit of one year(P>0.05).There was no statistically significant difference in levels of serum CRP、IL-6、TNF-α、IL-8 and SF-36scores between the two groups before surgery(P>0.05).On the third day after surgery,the levels of serum CRP、IL-6、TNF-α、IL-8 and SF-36scores in the two groups were significantly higher than those before surgery;the levels of CRP,IL-6,TNF-a and IL-8 in the open group were higher than those of the combined group and SF-36scores of all dimensions were significantly lower than those of the combined group,the difference was statistically significant(P<0.05).Conclusion:Hysteroscopy combined with laparoscopy in the treatment of type2~5uterine fibroids is better than traditional laparoscopic hysteromyomectomy with the advantages of short operation time,less pain,quick recovery and fewer complications.It can reduce inflammatory reaction and improve the quality of life of patients.