腹腔镜下微创手术治疗特殊部位子宫肌瘤的效果及对卵巢内分泌功能的影响

Effects of laparoscopic minimally invasive surgery for treating uterine fibroids at privileged sites and its influence on ovarian endocrine function

目的研究腹腔镜下微创手术治疗特殊部位子宫肌瘤的效果及对卵巢内分泌功能的影响。方法选择该院收治的子宫肌瘤患者104例,对照组(52例)采取开腹子宫肌瘤切除术,观察组(52例)行腹腔镜下子宫肌瘤切除术。应用ELISA法检测两组肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1、IL-6及心肌细胞P物质(SP)水平;应用放射免疫分析法(RIA)检测雌二醇(E2)、卵泡刺激素(FSH)、促黄体生成素(LH)水平。记录患者随访2年的情况。结果观察组患者所用手术时间明显长于对照组(P<0.01),观察组留置尿管时间、术中出血量、术后排气和排便时间、术后留置引流管时间、住院时间,以及术后3d的TNF-α、IL-1及IL-6水平均明显低于对照组(P<0.05)。术后,与对照组相比,观察组患者血清中SP、FSH和LH水平明显降低(P<0.05),E2水平明显升高(P<0.05)。两组患者手术中均未发生血管及脏器损伤。结论经腹腔镜下手术切除治疗特殊部位子宫肌瘤手术创伤小,减少手术导致机体的应激反应与疼痛反应,可加快卵巢分泌功能的恢复,利于术后康复。

Objective To study the effect of laparoscopic minimally invasive surgery in the treatment of uterine fibroids at privileged sites and its influence on ovarian secretion function.Methods One hundred and four patients with uterine fibroids in this hospital were selected.The control group(52 cases)adopted laparotomic hysteromyomectomy,and the observation group(52 cases)conducted the laparoscopic hysteromyomectomy.The levels of tumor necrosis factor(TNF)-α,interleukin-1(IL)-1,IL-6 and cardiomyocyte substance P(SP)were determined by enzyme-linked immunosorbent assay(ELISA).The radioimmunoassay(RIA)was used to determine the changes of estradiol(E2),follicle-stimulating hormone(FSH)and luteinizing hormone(LH).The follow-up conditions within 2 years were recorded.Results The operative time in the observation group was significantly longer than that in the control group(P<0.01),but the indwelling urine catheter time,intraoperative blood loss volume,postoperative exhaust defecation time,postoperative indwelling drainage tube time and hospital stay in the observation group were significantly lower than those in the control group(P<0.05).The levels of TNF-α,IL-1 and IL-6 on postoperative 3d in the observation group were significantly lower than those in the control group(P<0.05).Compared with control group,the serum SP level and levels of FSH and LH after operation in the observation group were significantly decreased(P<0.05),while the level of E2 in the observation group was significantly increased(P<0.05).There was no occurrence of complications of visceral and vascular injury in the two groups.Conclusion Laparoscopic uterine fibroids resection at privileged sites has less trauma,reduces the stress inflammatory response caused by operation,accelerates the recovery of ovarian secretion function and is beneficial to postoperative rehabilitation.