腹腔镜下子宫肌瘤剔除术对患者手术部位感染、炎症应激指标、IGF-1、AOPP水平及宫颈微循环的影响

Influences of laparoscopic myomectomy on surgical site infection,inflammatory stress,IGF-1,AOPP and cervical microcirculation

目的分析腹腔镜下子宫肌瘤剔除术对患者手术部位感染、炎症应激指标、胰岛素样生长因子1(IGF-1)、晚期氧化蛋白产物(AOPP)水平及宫颈微循环的影响。方法回顾性选取2019年2月至2022年2月空军第986医院收治的219例子宫肌瘤患者作为研究对象,根据手术治疗方法不同将其分为研究组(n=113)和对照组(n=106)。研究组行腹腔镜下子宫肌瘤剔除术,对照组行开腹子宫肌瘤剔除术。比较两组患者手术时间、术中出血量和术后手术部位感染情况。比较两组患者手术后24 h的血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)、P物质、皮质醇、去甲肾上腺素(NE)、多巴胺、胰岛素样生长因子-1(IGF-1)、晚期氧化蛋白产物(AOPP)水平和宫颈微循环指标。结果研究组患者的手术时间、术中出血量分别为(73.45±12.68)min、(205.54±39.78)mL,均低于对照组[(93.82±15.03)min和(307.51±55.37)mL],差异均有统计学意义(P<0.05)。研究组患者的术后手术部位感染发生率为0.88%(1/113),低于对照组[6.6%(6/106)],差异有统计学意义(P<0.05)。手术后24 h,研究组患者的血清PCT、CRP、IL-6、IL-8、TNF-α、P物质、皮质醇、NE、多巴胺、AOPP水平分别为(1.59±0.22)μg/L、(8.27±2.03)mg/L、(9.12±1.76)pg/mL、(12.15±1.39)pg/mL、(3.69±0.35)ng/mL、(5.48±0.81)μg/mL、(156.72±38.45)ng/mL、(336.58±25.10)ng/L、(549.68±20.89)mmol/24 h、(33.47±5.86)μmol/L,均低于对照组[(2.57±0.26)μg/L、(13.68±2.43)mg/L、(14.48±2.21)pg/mL、(17.46±1.50)pg/mL、(7.34±0.59)ng/mL、(8.19±1.45)μg/mL、(198.36±48.69)ng/mL、(396.75±28.59)ng/L、(667.87±25.32a)mmol/24 h、(56.44±7.72)μmol/L],IGF-1为(108.86±12.49)ng/mL,高于对照组[(81.19±10.37)ng/mL],差异均有统计学意义(P<0.05)。研究组患者的宫颈毛细血管管径、血流灌注、微血管管径分别为(5.68±0.65)μm、(1.02±0.18)V、(59.39±5.18)μm,均高于对照组[(3.51±0.49)μm、(0.36±0.09)V、(42.55±4.76)μm],差异均有统计学意义(P<0.05)。结论相对于开腹手术,腹腔镜下子宫肌瘤剔除术可降低手术部位感染发生率,减轻患者术后炎症创伤和氧化应激程度,降低手术对宫颈微循环指标及相关调节因子水平的影响。

Objective To analyze the influences of laparoscopic myomectomy on surgical site infection,inflammatory stress,insulin-like growth factors-1(IGF-1),advanced oxidation protein products(AOPP)and cervical microcirculation.Methods A total of 219 patients with uterine fibroids treated in 986th Air Force Hospital from February 2019 February 2022 were selected as the research subjects.According to the different surgical treatment methods,the patients were divided into the study group(n=113)and the control group(n=106).The study group received laparoscopic Uterine fibroid,and the control group received laparotomy Uterine fibroid.The surgical time,intraoperative bleeding,and postoperative infection at the surgical site between the two groups were compared.The serum procalcitonin(PCT),C-reactive protein(CRP),interleukin(IL)-6,IL-8,tumor necrosis factor(TNF)-α,substance P,cortisol,norepinephrine(NE),dopamine,insulin-like growth factors-1(IGF-1),advanced oxidation protein products(AOPP)and the cervical microcirculation at 24 hours after operation between the two groups were compared.Results The operation time and the intraoperative bleeding of the patients in the study group were(73.45±12.68)min,(205.54±39.78)mL,respectively,which were lower than those in the control group[(93.82±15.03)min,(307.51±55.37)mL],the differences were statistically significant(P<0.05).The incidence of surgical site infection of the patients in the study groups was 0.88%(1/113),which was lower than that in the control group[6.6%(6/106)],the difference was statistically significant(P<0.05).At 24 hours after operation,the serum levels of PCT,CRP,IL-6,IL-8,TNF-α,substance P,cortisol,NE,dopamine,IGF-1,AOPP of the patients in the study group were(1.59±0.22)μg/L,(8.27±2.03)mg/L,(9.12±1.76)pg/mL,(12.15±1.39)pg/mL,(3.69±0.35)ng/mL,(5.48±0.81)μg/mL,(156.72±38.45)ng/mL,(336.58±25.10)ng/L,(549.68±20.89)mmol/24 h,(33.47±5.86)μmol/L,respectively,which were lower than those in the control group[(2.57±0.26)μg/L,(13.68±2.43)mg/L,(14.48±2.21)pg/mL,(17.46±1.50)pg/mL,(7.34±0.59)ng/mL,(8.19±1.45)μg/mL,(198.36±48.69)ng/mL,(396.75±28.59)ng/L,(667.87±25.32a)mmol/24 h,(56.44±7.72)μmol/L],IGF-1 was(108.86±12.49)ng/mL,which was higher than that in the control group[(81.19±10.37)ng/mL],the differences were statistically significant(P<0.05).The diameter of cervical capillaries,blood perfusion and microvessels were(5.68±0.65)μm,(1.02±0.18)V,(59.39±5.18)μm,respectively,which were higher than those in the control group[(3.51±0.49)μm,(0.36±0.09)V,(42.55±4.76)μm],the differences were statistically significant(P<0.05).Conclusion Compared with open surgery,the laparoscopic myomectomy can increase the incidence of surgical site infection,reduce the degree of postoperative inflammation damages and oxidative stress,alleviate the impact of surgery on cervical microcirculation and related regulatory factor level.