不同手术方式对子宫肌瘤患者宫颈局部微循环及术后感染发生的影响分析

Analysis of the influence of different surgical methods on the local microcirculation of the uterus and the incidence of postoperative infection in patients with uterine fibroids

目的分析开腹、阴式与腹腔镜肌瘤剔除术在子宫肌瘤患者术后感染控制中的差异性及对患者宫颈局部微循环的影响。方法将2017年4月-2018年4月因子宫肌瘤于武汉市中心医院妇产科手术治疗的143例患者作为研究对象,参考患者自身意愿以及其临床特点采用不同手术方案治疗。其中行开腹肌瘤剔除术治疗的47例患者作为开腹组;行阴式肌瘤剔除术治疗的48例患者作为阴式组;行腹腔镜肌瘤剔除术治疗的48例患者作为腹腔镜组。对比三组不同手术方案下感染发生率、病原菌分布、宫颈局部微循环及手术前后各项血清炎性指标。结果腹腔镜组和阴式组术后感染发生率分别为2.08%、4.17%,均低于开腹组的19.15%(P<0.05);12例术后感染患者样本进行细菌培养共分离出17株病原菌,其中革兰阴性菌共11株,占64.71%,革兰阳性菌共6株,占35.29%;术后24 h腹腔镜组毛细血管管径、血流灌注、微血管管径均高于开腹组与阴式组,阴式组高于开腹组(P<0.05);术后24 h开腹组血清炎性指标表达水平均高于腹腔镜组和阴式组(P<0.05)。结论腹腔镜肌瘤剔除术应用于子宫肌瘤临床治疗中能有效改善宫颈局部微循环,降低术后感染率,疗效较优。及早检测术后感染患者致病菌类型,给予针对性抗菌药物治疗对患者意义重大。

OBJECTIVE To analyze the difference of laparotomy,vaginal and laparoscopic myomectomy in postoperative infection control of patients with uterine fibroids and its effect on local cervical microcirculation.METHODS A total of 143 patients who underwent surgical treatment of uterine fibroids from Apr.2017 to Apr.2018 in the hospital were enrolled in the study.The patients were treated with different surgical options according to their own wishes and their clinical features.Among them,47 patients who underwent open abdominal muscle tumor removal were included in the open group,48 patients who underwent vaginal myomectomy were included in the vaginal group,and 48 patients who underwent laparoscopic myomectomy were included in the laparoscopic group.The incidence of infection,the distribution of pathogens,the local microcirculation of the cervix and the serum inflammatory indexes before and after surgery were compared among the three groups.RESULTS The incidence of postoperative infection in the laparoscopic group(2.08%)and the vaginal group(4.17%)was significantly lower than that in the open group(19.15%)(P<0.05).A total of 17 strains of pathogens were isolated from the specimens of 12 patients with postoperative infection via bacterial culture,among which 11 strains of Gram-negative bacteria accounted for 64.71%and 6 strains of Gram-positive bacteria accounted for 35.29%.The capillary diameter,blood perfusion and microvessel diameter in the laparoscopic group 24 h after operation were higher than those of the open group and the vaginal group,and the values of the vaginal group were significantly higher than those of the open group(P<0.05).The levels of serum inflammatory indexes in the open group 24 h after operation were significantly higher than those of the other two groups(P<0.05).CONCLUSION Application of laparoscopic myomectomy can effectively improve the local microcirculation of the cervix and reduce the postoperative infection rate in the clinical treatment of uterine fibroids,with relatively good curative effect.Early detection of the type of pathogens in patients with postoperative infection and application of targeted antibacterial drugs is of great significance to the patients.