腹腔镜下全子宫切除术对良性病变患者围术期指标、凝血功能及卵巢储备指标影响

Influences of laparoscopic total hysterectomy of the patients with benign uterine lesions on their perioperative indexes,and their indexes of coagulation function and ovarian reserve

目的:分析腹腔镜下全子宫切除术对子宫良性病变患者围术期指标、血清脂联素(APN)及术后恢复的影响。方法:选取2020年9月—2022年9月在本院接受医治的170例子宫良性病变患者,依据手术治疗方式分为对照组(85例)和观察组(85例),分别接受经腹全子宫切除手术、腹腔镜全子宫切除手术。术后均常规抗感染治疗,比较两组围术期指标,检测手术前后患者凝血功能指标及卵巢储备功能指标。结果:观察组肛门排气时间(2.05±0.68d)、排便时间(2.64±0.86d)、住院时间(7.56±1.05d)均短于对照组(2.58±0.82d、3.08±0.93d、10.42±3.81d),术中出血量(204.41±15.81ml)少于对照组(248.47±20.25ml),术后并发症(5.9%)低于对照组(21.2%)(均P<0.05)。术后24 h两组凝血酶原时间、活化部分凝血活酶时间、血小板水平均较术前降低,对照组低于观察组(P<0.05),术后纤维蛋白原、D-二聚体水平均较术前升高,但观察组低于对照组,两组术后2个月血清卵泡刺激素、黄体生成素、抗苗勒管激素、抑制素B均降低,但观察组高于对照组,雌二醇水平升高,且观察组高于对照组(均P<0.05)。结论:腹腔镜下全子宫切除术可缩短患者术后恢复时间,减少术中出血量,对卵巢储备功能不良影响较小。

Objective:To analyze the influences of laparoscopic total hysterectomy of the patients with benign uterine lesions on their perioperative indexes,their serum adiponectin(APN)level,and their recovery after surgery.Methods:A total of 170patients with benign uterine lesions were selected as the research objects from September 2020to September 2022.According to the surgical methods,these patients were divided into control group(85cases)and observation group(85cases).The patients in the control group had received transabdominal total hysterectomy,and the patients in the observation group had received laparoscopic total hysterectomy.The patients in the two groups were given routine anti-infection treatment after surgery.The perioperative indexes of the patients were compared between the two groups.The indexes of coagulation function and the ovarian reserve function of the patients in the two groups were detected before and after operation.Results:The anal exhaust time(2.05±0.68d),the defecation time(2.64±0.86d),and the hospitalization time(7.56±1.05d)of the patients in the observation group were significantly shorter than those(2.58±0.82d,3.08±0.93d,and 10.42±3.81d)of the patients in the control group.The intraoperative blood loss(204.41±15.81ml)and the postoperative complications rate(5.9%)of the patients in the observation group were significantly lower than those(248.47±20.25ml and 21.2%)of the patients in the control group(all P<0.05).The prothrombin time,the activated partial thrombin time,and the platelet level of the patients in both groups in 24h after operation had decreased significantly,and which of the patients in the control group were significantly lower than those of the patients in the observation group(P<0.05).The levels of postoperative fibrinogen and D-dimer of the patients in both groups in 24hafter operation had increased significantly,and which of the patients in the observation control group were significantly lower than those of the patients in the control group.The levels of serum follicle stimulating hormone,luteinizing hormone,antimuller hormone,and statin B of the patients in both groups in 2 months after operation had decreased significantly,and which of the patients in the observation group were significantly higher than those of the patients in the control group.The level of estradiol of the patients in both groups in 2months after operation had increased significantly,and which of the patients in the observation group was significantly higher than that of the patients in the control group(all P<0.05).Conclusion:Laparoscopic total hysterectomy can significantly shorten the postoperative recovery time of the patients with benign uterine lesions,which can reduce the intraoperative blood loss,with less adverse influences on the ovarian reserve function of the patients.