腹腔镜囊肿剥除术治疗单侧卵巢子宫内膜异位囊肿对动脉血流动力学和血清过氧还蛋白亚型表达的影响

Influence of laparoscopic cystectomy for treating women with unilateral ovarian endometriotic cysts on their arterial hemodynamics and serum perredoxin subtypes expression

目的:探讨腹腔镜囊肿剥除术治疗单侧卵巢子宫内膜异位囊肿(OEC)及对动脉血流动力学和血清过氧还蛋白(PRX)亚型表达的影响.方法:回顾性分析2017年2月-2020年3月本院诊治的单侧OEC患者122例(观察组)与健康体检者45例(对照组)临床资料,观察组均予以腹腔镜囊肿剥除术,观察总有效率、手术时间、术中出血量、住院时间、复发率及术前、术后7d子宫动脉血流动力学(RI、PI、S/D)和过氧还蛋白亚型(PRX1、PRX2、PRX3)及卵巢功能相关指标;且根据术后有无复发分为复发组(n=28)与未复发组(n=94),分析影响术后复发的相关因素,受试者工作特征曲线(ROC)评估RI、PI、S/D、PRX1、PRX2、PRX3预测术后复发的价值.结果:观察组治疗后总有效率为93.4%,手术时间82.2±12.3min,术中出血量54.3±5.3ml,住院时间4.1±1.3d,术后随访12个月复发率23.0%;术前血流动力学指标高于对照组,而PRX1、PRX2、PRX3表达低于对照组;治疗后血流动力学指标降低,而PRX1、PRX2、PRX3表达升高(均P<0.05).观察组治疗前后雌二醇(E_(2))、卵泡刺激素(FSH)、黄体生成素(LH)无差异,且与对照组无差异(P>0.05).术后复发组与未复发组体质指数、初潮年龄、人工流产次数、E_(2)、FSH、LH、最大囊肿直径比较均无差异(P>0.05),年龄、病程、R-AFS分期、术后孕次、RI、PI、S/D、PRX1、PRX2、PRX3比较有差异(P<0.05).二元logistic回归分析显示,r-AFS分期为Ⅲ~Ⅳ期、术后孕次为0、年龄小、病程长、RI、PI、SD、PRX1、PRX2、PRX3表达异常均为影响OEC患者术后复发的危险因素(P<0.05).ROC分析,RI、PI、SD、PRX1、PRX2、PRX3预测OEC术后复发的曲线下面子(AUC)分别为0.580、0.661、0.826、0.680、0.754、0.752(P<0.05).结论:腹腔镜囊肿剥除术治疗OEC有效率高,且有利于降低复发率;通过检测动脉血流动力学和PRX亚型可为预测术后复发提供参考指标.

Objective: To explore the influence of laparoscopic cystectomy for treating women with unilateral ovarian endometriotic cysts(OEC)on their arterial hemodynamics and their serum perredoxin(PRX)subtypes expression.Methods:The clinical data of 122 women with unilateral OEC in observation group and 45 healthy women in control group from February 2017 to March 2020 were analyzed retrospectively.The women in the observation group had received laparoscopic cystectomy.The total effective rate,the operative time,the intraoperative blood loss,the hospitalization time,the recurrence rate,the values of uterine artery hemodynamics,such as RI,PI,and S/D,and the levels of serum perredoxin subtypes,such as PRX1,PRX2,and PRX3 before and in 7 days after operation,and the ovarian function-related indicators of the women in the observation group were observed.According to the OEC recurrence after operation,the women in the observation group were divided into group A 28 women with OEC recurrence)and group B(94 women without OEC recurrence).The relevant factors affecting OEC recurrence of the women in the observation group after operation were analyzed.The values of RI,PI,and S/D,and the levels of PRX1,PRX2,and PRX3 for predicting postoperative OEC recurrence of the women were assessed by receiver operator characteristic curve(ROC).Results:The total effective rate after treatment,the operation time,the intraoperative blood loss,the hospital stay,and the OEC recurrence rate after 12 months of follow-up of the women in the observation group were 93.4%,82.2±12.3min,54.3±5.3ml,4.1±1.3 days,and 23.0%,respectively.The preoperative hemodynamic indexes values of the women in the observation group were significantly higher than those of the women in the control group,while the expressions levels of PRX1,PRX2,and PRX3 of the women in the observation group were significantly lower.After treatment,the hemodynamic indexes values of the women in the observation group had decreased significantly,while the expressions levels of PRX1,PRX2,and PRX3 of the women in the observation group had increased significantly(all P<0.05).The levels estradiol(E_(2)),follicle stimulating hormone(FSH),and luteinizing hormone(LH)of the women in the observation group had no changed after treatment,and which had no significantly different from those of the women in the in the control group(P>0.05).There were no significant differences in the body mass index value,the age of menarche,the number of induced abortion,the levels of E_(2),FSH,and LH,and the maximum cyst significant diameter of the women between group A and group B(P>0.05),but there were significant differences in the age,the OEC duration,the OEC r-AFS stage,the number of postoperative pregnancy,the values of RI,PI,and S/D,and the PRX1,PRX2,and PRX3 levels of the women between group A and group B(P<0.05).Binary logistic regression analysis showed that OEC r-AFS stageⅢ-Ⅳ,the no postoperative pregnancy,the younger age,the longer disease course,the abnormal RI,PI,and SD values,and the abnormal expressions of PRX1,PRX2,and PRX3 of the women with OEC were the risk factors of their postoperative OEC recurrence(P<0.05).ROC analysis showed that the AUC of the values of RI,PI,and SD,and the levels of PRX1,PRX2,and PRX3 of the women with OEC for predicting their recurrence after OEC were 0.580,0.661,0.826,0.680,0.754,and 0.752,respectively(P<0.05).Conclusion:Laparoscopic cystectomy for treating women with OEC has high effect,which is beneficial to reduce the recurrence rate of OEC.The arterial hemodynamics and the PRX subtype detection of the women with OEC can be used as the reference indicators for predicting the postoperative OEC recurrence of these women.