腹腔镜配合阴式子宫切除对宫颈癌患者血清瘦素和胰岛素生长因子-Ⅱ及免疫功能的影响

Effects of laparoscopic-assisted vaginal radical hysterectomy on serum leptin,insulin growth factor-Ⅱand immune function in cervical cancer

目的探讨腹腔镜配合阴式子宫切除治疗对宫颈癌患者血清瘦素、胰岛素生长因子-Ⅱ(IGF-Ⅱ)及免疫功能的影响。方法选取2012年1月至2014年1月间陕西省汉中3201医院和惠州华康医院收治的150例宫颈癌患者。根据采取的手术方法不同进行分组,采用腹腔镜配合阴式子宫切除治疗的75例患者纳入观察组,采用开腹广泛子宫切除术治疗的75例患者纳入对照组。比较两组患者的临床疗效、血清瘦素、IGF-Ⅱ及T细胞亚群变化。结果与对照组相比,观察组患者的体温恢复正常时间、手术时间、肛门排气时间、术中出血量、抗生素应用时间、盆腔引流量及导管留置时间均较短,差异均有统计学意义(均P<0.05)。与对照组相比,观察组患者生活质量评分较高,差异有统计学意义(P<0.05)。两组患者的生存率和复发率比较,差异无统计学意义(P>0.05)。与术前相比,两组患者术后瘦素、IGF-Ⅱ水平均降低,且观察组术后的瘦素和IGF-Ⅱ水平低于对照组,差异有统计学意义(P<0.05)。两组患者术后CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)水平先下降后升高,差异均有统计学意义(P<0.05)。与对照组相比,观察组术后1d和5d的CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)均更高,差异均有统计学意义(均P<0.05)。观察组不良反应率为8.9%,低于对照组的22.2%,差异有统计学意义(P<0.05)。结论腹腔镜配合阴式子宫切除治疗对宫颈癌患者效果较好,患者术后生活质量高,免疫功能恢复快,且能有效降低血清瘦素和IGF-Ⅱ水平,值得临床推广使用。

Objective To explore the effects of laparoscopic-assisted vaginal radical hysterectomy on serum leptin,insulin growth factor-Ⅱand immune function in cervical cancer.Methods One hundred and fifty patients with cervical cancer admitted to 3201 Hospital and Huakang Hospital were selected between January 2012 and January 2014.They were categorized into different groups based on the treatment methods.Seventy-five patients undergoing laparoscopic-assisted vaginal radical hysterectomy were included in an observation group and 75 patients undergoing abdominal hysterectomy were included in a control group.Clinical efficacy and changes in serum leptin,IGF-Ⅱand T cell subsets were compared between the two groups.Results Time to recovery of normal body temperature,duration of operation,anal exhaust time,intraoperative blood loss,use of antibiotics,pelvic drainage,and length of catheter stay were significantly lower in the observation group than in the control group(all P<0.05).Quality of life score was significantly higher in the observation group than in the control group(P<0.05).There was no significant difference in the survival rate and recurrence rate between the two groups(P>0.05).The level of serum leptin and IGF-Ⅱwas decreased in the two groups after the surgery(all P<0.05),and these levels were lower in the observation group than in control group(all P<0.05).The levels of CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)in the two groups were decreased and then increased(all P<0.05).The levels of CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)was significantly higher in observation group than in control group at 1 d and 5 d after the surgery(all P<0.05).The incidence of adverse reactions was 8.9%in observation group which was significantly lower than 22.2%of the control group(P<0.05).Conclusion Laparoscopic-assisted vaginal radical hysterectomy is effective for cervical cancer,which may result in high quality of life,quick recovery of immune function and reduction in serum leptin and IGF-Ⅱlevels,which is worthy of expansion in clinical practice.