无气腹与气腹腹腔镜辅助阴式全子宫切除术的效果比较

Comparison of effects of laparoscopic assisted transvaginal hysterectomy with and without pneumoperitoneum

目的:比较无气腹与气腹腹腔镜辅助阴式全子宫切除术中的应用效果。方法:选取109例择期行腹腔镜辅助阴式全子宫切除术患者为研究对象,按照随机数字表法分为对照组(n=53)和观察组(n=56)。对照组采用气腹腹腔镜辅助阴式全子宫切除术,观察组采用无气腹腹腔镜辅助阴式全子宫切除术,比较两组手术相关指标(手术时间、术中出血量)水平、不同时间点[麻醉前(T1)、建立气腹或悬吊1 h后(T2)]平均动脉压(MAP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、T2时血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))、碱剩余(BE)]水平,以及肛门排气时间、术后住院时间、住院总费用和并发症发生率。结果:观察组手术时间短于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05);T2时,两组MAP、TNF-α和IL-6水平均高于T1时,但观察组低于对照组,差异有统计学意义(P<0.05);观察组PaCO_(2)水平低于对照组,BE水平高于对照组,差异均有统计学意义(P<0.05);两组PaO_(2)、SaO_(2)水平比较,差异均无统计学意义(P>0.05);观察组肛门排气时间短于对照组,治疗总费用少于对照组,差异均有统计学意义(P<0.05);两组术后住院时间和并发症发生率比较,差异均无统计学意义(P>0.05)。结论:与传统气腹腹腔镜相比,无气腹腹腔镜辅助阴式全子宫切除术可缩短手术时间和肛门排气时间,减少术中出血量和治疗总费用,以及降低MAP、TNF-α和IL-6水平。

Objective:To compare application effects of laparoscopic assisted transvaginal hysterectomy with and without pneumoperitoneum.Methods:109 patients undergoing elective laparoscopic assisted transvaginal hysterectomy were selected as the research objects,and were divided into control group (n=53) and observation group (n=56) according to the random number table method.The control group was treated with laparoscopic assisted transvaginal hysterectomy with pneumoperitoneum,while the observation group was treated with laparoscopic assisted transvaginal hysterectomy without pneumoperitoneum.The levels of surgery-related indicators (operation time,intraoperative blood loss),the mean arterial pressure (MAP) levels at different time points[before anesthesia (T;),1 h after pneumoperitoneum or suspension (T;)],the tumor necrosis factor (TNF)-α level,the interleukin 6 (IL-6) level,the blood gas indicator levels at T;[arterial partial pressure of oxygen (PaO;),arterial partial pressure of carbon dioxide (PaCO_(2)),blood oxygen saturation (SaO_(2)),base excess (BE)]the anal exhaust time,the postoperative hospitalization time,the total hospital costs and the incidence of complications were compared between the two groups.Results:The operation time of the observation group was shorter than that of the control group,the intraoperative blood loss was less than that of the control group,and the differences were statistically significant (P<0.05).At T;,the levels of MAP,TNF-α and IL-6 in the two groups were higher than those at T;but those of the observation group were lower than those of the control group;and the differences were statistically significant (P<0.05).The level of PaCO_(2) in the observation group was lower than that in the control group;the level of BE was higher than that in the control group;and the differences were statistically significant (P<0.05).There were no significant differences in the PaO;and SaO_(2) levels between the two groups (P>0.05).The anal exhaust time of the observation group was shorter than that of the control group;the total treatment cost was less than that of the control group;and the differences were statistically significant (P<0.05).There were no significant difference in the postoperative hospitalization time and the incidence of complications between the two groups (P>0.05).Conclusions:The laparoscopic assisted transvaginal hysterectomy without pneumoperitoneum can shorten the operative time and the anal exhaust time,reduce the intraoperative blood loss and the total treatment cost,and reduce the MAP,TNF-α and IL-6 levels.Moreover,it is superior to laparoscopic assisted transvaginal hysterectomy with pneumoperitoneum.