腹腔镜与开腹对行全子宫切除术患者手术学指标、应激反应、预后的影响对比研究

Comparative study on the effects of laparoscopy and laparotomy on surgical indexes,stress response and prognosis of patients undergoing total hysterectomy

目的:探讨腹腔镜与开腹对行全子宫切除术患者手术学指标、应激反应、预后的影响。方法:回顾性分析2017年3月~2020年2月我院妇产科子宫良性病变行全子宫切除术患者64例,根据手术方式,分为腹腔镜组(n=31例)与开腹术组(n=33),比较两组围术期指标、应激反应、卵巢功能、盆底功能以及术后并发症发生情况。结果:两组手术时间比较;腹腔镜组术中出血量少于开腹术组,肛门排气时间、术后下床时间、住院总天数短于开腹术组;腹腔镜组术后1d、术后3d血清白细胞介素(IL-6)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)水平均低于开腹术组;两组术后3个月血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)水平比较;腹腔镜组术后3个月Ⅰ类、Ⅱ类肌纤维肌力高于开腹术组,Ⅰ类、Ⅱ类肌纤维疲劳度低于开腹术组;腹腔镜组术后并发症发生率9.68%低于开腹术组33.33%。结论:腹腔镜全子宫切除术治疗子宫良性病变手术创伤小,术中出血少,术后恢复快,相较于开腹手术有利于保护患者盆底功能,降低术后并发症发生率,不增加卵巢受损程度。

Objective To explore the effects of laparoscopy and laparotomy on surgical indexes,stress response and prognosis of patients undergoing total hysterectomy.Methods A total of 64 patients with benign uterine lesions who underwent total hysterectomy in obstetrics and gynecology department of the hospital from March 2017 to February 2020 were retrospectively analyzed.According to different surgical methods,they were divided into laparoscopy group (n=31) and laparotomy group (n=33).The perioperative indexes,stress response,ovarian function,pelvic floor function and occurrence of postoperative complications were compared between the two groups.Results There was no significant difference in operation time between the two groups.The intraoperative blood loss in laparoscopy group was less than that in laparotomy group,anal exhaust time,postoperative leaving bed time and total hospitalization time were shorter than those in laparotomy group.At 1d and 3d after surgery,levels of serum interleukin (IL-6),tumor necrosis factor α (TNF-α) and C-reactive protein (CRP) in laparoscopy group were lower than those in laparotomy group.There were no significant differences in levels of serum follicle stimulating hormone (FSH),luteinizing hormone (LH),estradiol (E2) and progesterone (P) at 3 months after surgery between the two groups.At 3 months after surgery,muscle strength of type I and type II muscle fibers in laparoscopy group was higher than that in laparotomy group,while fatigue of type I and type II muscle fibers was lower than that in laparotomy group.The incidence of postoperative complications in laparoscopy group was lower than that in laparotomy group (9.68% vs 33.33%).Conclusion There is little surgical trauma,less intraoperative blood loss and fast postoperative recovery in patients with benign uterine lesions treated with laparoscopic total hysterectomy.Compared with laparotomy,the former is beneficial to protect pelvic floor function,and reduce the incidence of postoperative complications in patients,without aggravating ovarian damage.