子宫肌瘤不同子宫全切术式对患者炎性因子、应激激素的影响

Effects of different hysterectomy methods for treating patients with uterine fibroids on their inflammatory factors and stress hormones

目的:比较子宫肌瘤不同子宫全切术后患者炎性因子、应激激素的差异。方法:收集2018年4月-2020年12月本院妇科因子宫肌瘤行子宫切除术328例临床资料,按照不同的手术方式分为经腹全子宫切除术(TAH)TAH组109例、阴式全子宫切除术(TVH)TVH组85例、腹腔镜全子宫切除术(LH)LH组134例。酶联免疫吸附试验检测患者血清肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)、C反应蛋白(CRP)、甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)、皮质醇(Cor)。结果:手术时间TAH组、LH组、TVH组依次缩短,术中出血量、住院时间TVH组及LH组无差异但均少于TAH组,术后24h及48h TVH组和LH组血清TNF-α、IL-8、CRP水平无差异但均低于TAH组,TAH组、LH组、TVH组血清NE、AngⅡ、Cor水平依次降低(均P<0.05)。手术时间与血清TNF-α、IL-8、CRP、NE、AngⅡ、Cor水平呈正相关(P<0.05),术中出血量与血清TNF-α、IL-8、CRP无相关性(P>0.05),与血清NE、AngⅡ、Cor呈正相关(P<0.05)。结论:与TAH比较,TVH、LH的术后患者炎性反应及应激反应较低,TVH术后炎性应激反应更低,更有利于患者术后康复。

Objective: To compare the differences of postoperative inflammatory factors and stress hormones levels of patients with uterine fibroids after different hysterectomy methods. Methods: The clinical data of 328 patients who underwent hysterectomy due to uterine fibroids from April 2018 to December 2020 were selected as the research subjects. The patients were divided into group A(109 cases with transabdominal hysterectomy), group B(85 cases with transvaginal hysterectomy), and group C(134 cases with laparoscopic hysterectomy) according to different surgical methods. The levels of serum tumor necrosis factor-α(TNF-α), interleukin-8(IL-8), C-reactive protein(CRP), norepinephrine(NE), angiotensin Ⅱ(AngⅡ), and cortisol(Cor) of the patients in the three groups were detected by enzym-linked immunosorbent assay. Results: The operative time of the patients in group A, group C, and group B had shortened gradually. The intraoperative blood loss and the time of hospital stay of the patients in group B and group C had no significant different, but which were all significantly less than that of the patients in group A. The serum TNF-α, IL-8 and CRP levels of the patients in group B and group C in postoperative 24 h and 48 h had no significant different, but which were all significantly lower than those of the patients in group A. The levels of serum NE, Ang Ⅱand Cor of the patients in group A, group C, and group B had decreased gradually(all P<0.05). The operative time of the patients was positively correlated with their serum levels of TNF-α, IL-8, CRP, NE, Ang Ⅱ, and Cor(P<0.05). The intraoperative blood loss of the patients had no correlation with their serum levels of TNF-α, IL-8, and CRP(P>0.05),but was positively correlated with their serum levels of NE,Ang Ⅱ,and Cor(P<0.05).Conclusion:Compared with those of TAH,the patients after TVH and LH have lower postoperative inflammatory response and stress response.And the postoperative inflammatory response of patients after TVH is the lowest,which is more beneficial to postoperative recovery of the patients.