腹腔镜与开腹全子宫切除术对子宫病变患者围术期的影响

Effects of laparoscopic and open hysterectomy on perioperative period in patients with uterine diseases

目的:探究腹腔镜全子宫切除术(Laparoscopically total hysterectomy,LTH)与开腹全子宫切除术(Total abdominal hysterectomy,TAH)对子宫病变患者创伤应激、内分泌功能的影响。方法:选取河南宏力医院108例子宫病变患者(2019年2月至2022年2月),随机分成A组(n=54)、B组(n=54)。B组接受TAH治疗,A组接受LTH治疗。术后住院期间,对比两组围术期指标(术中失血量、导尿管留置时长、手术时长、肛门排气时间);术后1m和3m,采用放射免疫分析法测定雌二醇(Estradiol,E2)、促黄体生成素(Luteinizing hormone,LH)、卵泡刺激素(Follicle stimulating hormone,FSH)水平;术后1 d、3 d,采用化学发光法检测游离三碘甲状腺原氨酸(Free triiodothyronine,FT3)、游离甲状腺素(Free triiodothyronine,FT4)、皮质醇(Cortisol,COR)水平,采用酶联免疫吸附法检测血清白细胞介素-6(Interleukin-6,IL-6)水平。结果:与B组相比,A组术中失血量明显更少,导尿管留置时长、肛门排气时间明显更短,手术时间明显更长(P<0.05);与术前相比,各治疗组的血清LH、FSH水平明显升高,血清E2水平明显降低(P<0.05),其中B组更为显著(P<0.05);与术前相比,各治疗组的血清FT3、IL-6、FT4、COR水平明显升高(P<0.05),其中B组更为显著(P<0.05)。结论:相较于TAH治疗子宫病变患者,应用LTH治疗于优化围术期指标方面更具优势,且对机体内分泌功能及创伤应激水平影响更小,但手术时长略长。

Objective:To explore the effects of laparoscopic total hysterectomy(LTH)and total abdominal hysterectomy(TAH)on traumatic stress and endocrine function in patients with uterine diseases.Methods:108 patients with uterine diseases in Henan Hongli Hospital(February 2019 to February 2022)were randomly divided into group A(n=54)and group B(n=54).Group B received TAH treatment and group A received LTH treatment.During hospitalization after the operation,perioperative indexes(intraoperative blood loss,catheter indwelling time,operation time,anal exhaust time)were compared between group A and group B;after 1 month,3 months of operation,the levels of estradiol(E2),luteinizing hormone(LH),follicle-stimulating hormone(FSH)were measured by radioimmunoassay;after 1 day,3 days of operation,the levels of free triiodothyronine(FT3),free triiodothyronine(FT4),cortisol(COR)were measured by chemiluminescence method,the level of interleukin-6(IL-6)was measured by Enzyme-linked immunosorbent assay.Results:Compared with group B,group A had significantly less intraoperative blood loss,shorter catheter retention time,shorter anal exhaust time,and significantly longer operation time(P<0.05);compared with preoperative,the levels of serum LH and FSH in each treatment group were significantly higher,and the level of serum E2 was significantly lower(P<0.05),especially in group B(P<0.05);compared with preoperative,the serum levels of FT3,IL-6,FT4 and COR in each treatment group were significantly higher(P<0.05),especially in group B(P<0.05).Conclusion:Compared with TAH in the treatment of patients with uterine diseases,LTH has more advantages in optimizing perioperative indicators,and has less impact on endocrine function and traumatic stress level,but the operation duration is slightly longer.