TAP结合腹腔镜下间隙分离在卵巢囊肿中的应用效果及对CD4+/CD8+的影响

Effect of TAP combined with laparoscopic gap separation in ovarian cysts and its effect on CD4+/CD8+

目的探究腹腔镜下间隙分离结合腹横肌平面阻滞麻醉(transversus abdominis plane,TAP)在卵巢囊肿治疗中的疗效及其对患者CD4^(+)/CD8^(+)的影响。方法行回顾性分析,将焦作市人民医院2018年3月—2021年12月收治的105例卵巢囊肿患者纳为研究对象,根据其手术及麻醉方式,将其分为A组及B组,A组行腹腔镜下直接剥除术,手术结束前30 min给地佐辛,B组麻醉诱导后在B超引导下行TAP并实施腹腔镜下间隙分离手术。比较两组麻醉药物用量、术后镇痛效果、外周血CD4^(+)/CD8^(+)水平、卵巢功能。结果与同组手术开始前5 min(T_(0))时刻相比,两组术中插管后5 min(T_(1))时刻SBP、DBP以及HR水平均下降,做切口时(T_(2))时刻以上指标水平均有所回升,但均低于T_(0)时刻水平,差异有统计学意义(P<0.05),但B组T_(1)、T_(2)、T_(3)时刻SBP、DBP以及HR水平均高于A组对应时段水平,差异具有统计学意义(P<0.05)。两组手术时间比较,差异无统计学意义(P<0.05),但B组术中出血量及住院时间均少于/短于A组,差异具有统计学意义(P<0.05)。B组术后2 h、6 h、12 h及24 h VAS评分均低于A组,差异具有统计学意义(P<0.05)。A组术后CD4^(+)/CD8^(+)水平较其术前下降,差异具有统计学意义(P<0.05),B组手术前后CD4^(+)/CD8^(+)水平比较,差异无统计学意义(P<0.05),两组术后血清CRP以及IL-6水平均较其术前下降,差异具有统计学意义(P<0.05),B组术后CD4^(+)/CD8^(+)水平较A组高,血清CRP及IL-6水平低于A组,差异具有统计学意义(P<0.05)。术后6个月,B组的LH、FSH浓度水平较A组低,AMH及AFC浓度水平较A组高,差异具有统计学意义(P<0.05)。结论腹腔镜下间隙分离结合TAP能够有效减轻卵巢囊肿患者术后疼痛程度,减少手术操作对卵巢组织造成的不良影响,有助于患者术后恢复。

Objective To investigate the effect of laparoscopic gap separation combined with transversus abdominis plane(TAP)in ovarian cysts,and to analyze its effect on CD4^(+)/CD8^(+).Methods A retrospective analysis was conducted on 105 patients with ovarian cysts admitted to the hospital from March 2018 to December 2021.Patients were classified into group A and group B according to different operation and anesthesia methods.Group A underwent direct laparoscopic cystectomy and dezocine was injected 30 min before the end of the procedure,while group B underwent ultrasound-guided TAP anesthesia and laparoscopic gap separation.Then the dosage of anesthetic drugs,postoperative analgesia effect,peripheral blood CD4^(+)/CD8^(+)level and ovarian function were compared between two groups.Results Compared with the indicators at 5min before surgery(T_(0)),systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)decreased in both groups at 5min after intraoperative intubation(T_(1)),and the above indicators increased slightly at T_(2),but were still lower than those at T_(0),with statistical significance(all P<0.05).SBP,DBP and HR at T_(1),T_(2)and T_(3)in group B were higher than that of group A,with statistical significance(P<0.05).The operation time had no statistical difference between two groups,while the group B had obvious lower intraoperative blood loss and shorter hospital stay length compared with those of group A(P<0.05).Visual Analogue Scale scores at postoperative 2 h,6 h,12 h and 24 h were significantly lower in observation group than that of control group(P<0.05).After operation,CD4^(+)/CD8^(+)level was decreased in group A(P<0.05),while had no significant changes in group B(P>0.05).A significant decrease was found in serum levels of C-reactive protein(CRP)and interleukin-6(IL-6)in both groups after operation(P<0.05).Compared with group B,group A had significantly higher CD4^(+)/CD8^(+)level as well as lower CRP and IL-6 levels(P<0.05).Six months after surgery,the levels of follicle stimulating hormone(FSH)and luteinizing hormone(LH)in group B were lower than that of group A,and the levels of anti-Mullerian hormone(AMH)and antral follicle count(AFC)were higher than that of group A,with statistical significant(P<0.05).Conclusion Application of TAP combined with laparoscopic gap separation in ovarian cysts can effectively ameliorate the pain degree,alleviate the adverse effects and promote the recovery.