单孔或多孔腹腔镜用于子宫肌瘤切除术效果比较

Comparison of the effect of single port laparoscope and multi-port laparoscope used in hysteromyomectomy

目的:对比分析单孔腹腔镜(LESS)与多孔腹腔镜(MPLS)用于子宫肌瘤切除术效果。方法:随机将2018年4月-2020年4月在本院诊治的子宫肌瘤患者120例分组,对照组60例实施MPLS术,观察组60例行LESS术。分析两组手术指标、术前及术后3d炎性指标[白细胞介素(IL-6)、超敏C反应蛋白(hs-CRP)]及血清干扰素(IFN-γ)、术前和术后1个月卵巢储备功能[促卵泡生成素(FSH)、雌二醇(E_(2))、黄体生成素(LH)、基础窦状细胞(AFC)个数],统计并发症,评估美容效果,随访记录月经异常、再次妊娠、肌瘤复发情况。结果:观察组术后肛门排气时间、术后视觉模拟评分(VAS)、住院时间优于对照组,手术时间较对照组延长(均P<0.05),两组术中出血量相当(P>0.05)。术后3d,两组IL-6、hs-CRP均提高但观察组低于对照组,IFN-γ水平观察组低于对照组(均P<0.05);术后1个月,两组血清FSH、LH水平均提高,E_(2)降低但观察组变化幅度低于对照组(均P<0.05);术后6个月两组FSH、LH、E_(2)水平相当(P>0.05);两组术前、术后1及6个月AFC无明显改变(P>0.05);观察组并发症率(5.0%)与对照组(3.3%)无差异(P>0.05)。观察组术后体象量表BIS评分低于对照组,切口美观满意度CS评分高于对照组(P<0.05)。两组均接受随访,随访时间14~24个月,随访中位数为18个月,观察组月经均正常,对照组月经异常1例,两组均无肌瘤复发情况,观察组再妊娠8例(13.3%),观察组再妊娠3例(5.0%),观察组与对照组各随访指标无差异(P>0.05)。结论:LESS术后或MPLS在子宫肌瘤切除术中近远期效果相似,但LESS炎症反应更小,可更好改善IFN-γ,促进患者早期卵巢储备功能恢复,获得较好美容效果。

Objective:To analyze the effect of single port laparoscope(SPLS)and multi-port laparoscope(MPLS)used in hysteromyomectomy.Methods:120 patients diagnosed as uterine fibroids were randomly divided into two groups(60 cases in each group)from April 2018 to April 2020.The patients in the observation group had undergone MPLS surgery,and the patients in the control group had undergone SPLS surgery.The surgical indicators,the levels of inflammatory indicators[interleukin(IL-6),high-sensitivity C-reactive protein(hs-CRP)],and serum interferon-γ(IFN-γ)of the patients in the two groups before surgery and 3 days after surgery,and the levels of ovarian reserve function[follicle stimulating hormone(FSH),estradiol(E_(2)),luteinizing hormone(LH),basal sinusoidal cells(AFC)]of the patients in the two groups before surgery and 1 month after surgery were analyzed.The complication rate of the patients in the two groups was counted,and the beauty effect of the patients in the two groups was evaluated.All the patients were followed up at least 1 year,and the situations of the abnormal menstruation,the re-pregnancy,and the recurrence of fibroids of the patients in the two groups were recorded.Results:The postoperative anal exhaust time,the postoperative visual analogue score(VAS),and the hospitalization time of the patients in the observation group were significantly better than those of the patients in the control group,and the operation time of the patients in the observation group was significantly longer than that of the patients in the control group(all P<0.05).There were no significant difference in bleeding loss during operation of the patients between the two groups(P>0.05).The levels of IL-6 and Hs-CRP of the patients in both groups in 3 days after operation had increased significantly,but which of the patients in the observation group were significantly lower than those of the patients in the control group,The IFN-γlevel of the patients in the observation group was significantly lower than that of the patients in the control group(all P<0.05).The levels of FSH and LH of the patients in both groups in 1 month after operation had increased significantly,but the E2 level had decreased significantly,the change degree of which of the patients in the observation group were significantly lower than those of the patients in the control group(all P<0.05).The AFC value of the patients in both groups before operation,in 1 month and 6 months after operation were similar(P>0.05).There were no significant difference in the serum FSH,LH and E2 levels of the patients in 6 month after operation between the two groups(P>0.05).There was no significant difference in the complication rate(5.0%vs.3.3%)of the patients between the two groups(P>0.05).BIS score of the patients in the observation group was significantly lower than that of the patients in the control group,and CS score of incision aesthetic satisfaction of the patients in the observation group was significantly higher(P<0.05).The patients in both groups were followed up for 14-24 months,with a median of 18 months of followed up.Menstruation of the patients in the observation group was normal,and the abnormal menstruation of one patient in the control group was observed.There were no recurrence of myoma of the patients occurred in both groups.There were 8(13.3%)cases with repregnancy in the observation group and 3(5.0%)cases with repregnancy in the control group.There were no significant differences in different indexes of the patients during followed up between the two groups(P>0.05).Conclusion:SPLS and MPLS used in hysteromyomectomy of the patients have the similar short-term and long-term effects,but SPLS causes less inflammatory response,and can improve their IFN-γlevel,can be more conducive to the recovery of ovarian reserve function of the patients early,and can help them obtain better cosmetic effect.