体位调整联合加压冲洗对腹腔镜卵巢子宫内膜异位囊肿剥除术中冲洗效果的影响

Effect of position adjustment combined with pressure flushing on flushing effect of laparoscopic ovarian endometriosis cyst removal

目的探讨体位调整联合加压冲洗对腹腔镜卵巢子宫内膜异位囊肿剥除术中冲洗效果的影响。方法选取全身麻醉下行腹腔镜卵巢子宫内膜异位囊肿剥除术的66例患者作为研究对象,采用随机数字表法分为对照组和观察组,每组33例。对照组给予1000 mL生理盐水于头低脚高30°体位下常规冲洗,观察组在对照组冲洗基础上予以冲洗体位调整,且全程加压冲洗。检测并比较2组患者气腹建立完成后(干预前)、冲洗结束后(干预后)腹腔液糖类抗原125(CA125)、血管内皮生长因子(VEGF)水平。结果干预前,2组腹腔液CA125、VEGF水平比较,差异均无统计学意义(P>0.05);干预后,2组腹腔液CA125、VEGF水平均低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组干预前后腹腔液CA125、VEGF水平差值均大于对照组,差异有统计学意义(P<0.05)。结论在腹腔镜卵巢子宫内膜异位囊肿剥除术中采用体位调整联合加压冲洗,可降低腹腔液CA125、VEGF水平,减少盆腔中脱落的内膜细胞残留,降低内膜细胞扩散种植的概率。

Objective To explore the effect of position adjustment combined with pressure irrigation on irrigation effect of laparoscopic ovarian endometriosis cyst removal.Methods A total of 66 patients undergoing laparoscopic ovarian endometriosis cyst removal surgery under general anesthesia were selected as study objects,and were divided into control group(n=33)and observation group(n=33)by random number table method.The control group was given 1000 mL saline for washing at 30°degree in Trendelenburg position.The observation group was adjusted the surgical position when washing on the basis of the control group,and given pressed washing in whole process.The levels of carbohydrate antigen 125(CA125)and vascular endothelial growth factor(VEGF)in peritoneal fluid were detected and compared between the two groups after pneumoperitoneum establishment(before intervention)and after irrigation(after intervention).Results Before intervention,the levels of CA125 and VEGF in the peritoneal fluid in the two groups showed no statistically differences(P>0.05).After intervention,the levels of CA125 and VEGF in the peritoneal fluid were lower than intervention before,and were lower in the observation group than those in the control group(P<0.05).The difference value before and after intervention in CA125 and VEGF levels in the observation group was greater than that of the control group(P<0.05).Conclusion Postural adjustment combined with pressurized irrigation during laparoscopic ovarian endometriosis cyst removal can reduce the levels of CA125 and VEGF in peritoneal fluid,reduce the residue of exfoliated intimal cells in the pelvic cavity,and decrease the probability of diffusion of inner membrane cells.