腹腔镜手术对子宫内膜异位症患者血清VCAM-1、PAI-1水平及预后的影响

Effect of laparoscopic surgery on serum VCAM-1 and PAI-1 levels and prognosis in patients with endometriosis

目的 探究腹腔镜手术对子宫内膜异位症(EMT)患者血清血管细胞黏附因子-1(VCAM-1)、纤溶酶原激活物抑制因子-1 (PAI-1)水平及预后的影响。方法 前瞻性选取2020年1月至2022年1月河南中医药大学第三附属医院妇产科收治的167例EMT患者作为研究对象,采用随机数表法分为常规组83例(行开腹手术)和微创组84例(行腹腔镜手术)。比较两组患者的手术与术后康复情况、手术前后的VCAM-1、PAI-1水平和卵巢功能[窦状卵泡数目(AFC)、卵巢动脉的收缩期峰值血流速度(PSV)、抗苗勒管激素(AMH)]、临床疗效,以及随访1年时的尿失禁发生率和妊娠率。结果 微创组患者的手术时间、术中出血量、病灶剥除厚度、术后胃肠功能恢复时间、住院天数分别为(36.14±6.58) min、(69.85±10.57) m L、(0.53±0.09) mm、(1.25±0.21) d、(3.29±0.98) d,明显短(少)于常规组的(73.21±8.17) min、(175.43±17.54) m L、(0.68±0.10) mm、(1.54±0.24) d、(5.74±1.19) d,差异均有统计学意义(P<0.05);微创组患者术后1 d的血清VCAM-1、PAI-1水平分别为(262.64±25.43) pg/mL、(296.59±30.57) mg/L,术后3 d分别为(221.41±22.39) pg/mL、(254.33±32.54) mg/L,明显低于常规组术后1 d的(314.74±27.32) pg/mL、(378.47±31.52) mg/L和术后3 d的(279.88±23.17) pg/mL、(300.49±31.58) mg/L,差异均有统计学意义(P<0.05);微创组术后1个月患者的AFC、PSV、AMH分别为(4.19±0.31)个、(13.89±1.97) cm/s、(1.57±0.38) ng/mL,术后3个月分别为(4.52±0.38)个、(15.11±2.15) cm/s、(1.71±0.41) ng/mL,明显高于常规组术后1个月的(3.95±0.29)个、(11.95±1.86) cm/s、(1.26±0.35) ng/mL和术后3个月的(4.23±0.41)个、(12.98±2.07) cm/s、(1.52±0.39) ng/mL,差异均有统计学意义(P<0.05);微创组患者的治疗总有效率为95.24%,明显高于常规组的84.24%,差异有统计学意义(P<0.05);术后1年,微创组患者的尿失禁发生率为5.06%,明显低于常规组的18.42%,妊娠率为56.96%,明显高于常规组的38.15%,差异均有统计学意义(P<0.05)。结论 腹腔镜手术治疗EMT能优化手术操作,提高疗效,同时抑制血清VCAM-1,PAI-1的释放,降低术后尿失禁风险,可促进卵巢功能恢复,更好地改善妊娠情况与患者预后。

Objective To investigate the effect of laparoscopic surgery on the levels of vascular cell adhesion molecule-1(VCAM-1)and plasminogen activator inhibitor-1(PAI-1)in patients with endometriosis(EMT)and their prognosis.Methods A prospective study was conducted on 167 patients with EMT admitted to the Department of Ob-stetrics and Gynecology,the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from Janu-ary 2020 to January 2022.The patients were randomly divided into a conventional group(83 cases)and a minimally in-vasive group(84 cases)using a random number table.The surgical and postoperative rehabilitation conditions,pre-and postoperative VCAM-1 and PAI-1 levels,ovarian function[antral follicle count(AFC),peak systolic velocity(PSV)of ovarian artery,anti-Müllerian hormone(AMH)],clinical efficacy,and incidence of urinary incontinence,and pregnancy rate at 1-year follow-up were compared between the two groups.Results The operation time,intraopera-tive blood loss,lesion stripping thickness,postoperative gastrointestinal function recovery time,and length of hospital stay in the minimally invasive group were(36.14±6.58)min,(69.85±10.57)mL,(0.53±0.09)mm,(1.25±0.21)d,and(3.29±0.98)d,respectively,which were significantly shorter(less)than(73.21±8.17)min,(175.43±17.54)mL,(0.68±0.10)mm,(1.54±0.24)d,and(5.74±1.19)d in the conventional group(P<0.05).The serum VCAM-1 and PAI-1 levels in the minimally invasive group were(262.64±25.43)pg/mL and(296.59±30.57)mg/L on day 1 after surgery and(221.41±22.39)pg/mL and(254.33±32.54)mg/L on day 3 after surgery,which were significantly lower than(314.74±27.32)pg/mL and(378.47±31.52)mg/L in the conventional group on day 1 after surgery and(279.88±23.17)pg/mL and(300.49±31.58)mg/L on day 3 after surgery(P<0.05).The AFC,PSV,and AMH of patients in the minimally inva-sive group were(4.19±0.31)pieces,(13.89±1.97)cm/s,and(1.57±0.38)ng/mL at one month after surgery and(4.52±0.38)pieces,(15.11±2.15)cm/s,and(1.71±0.41)ng/mL at three months after surgery,which were significantly higher than(3.95±0.29)pieces,(11.95±1.86)cm/s,and(1.26±0.35)ng/mL of the conventional group at one month after surgery and(4.23±0.41)pieces,(12.98±2.07)cm/s,and(1.52±0.39)ng/mL at three months after surgery(P<0.05).The total ef-fective rate of treatment in the minimally invasive group was 95.24%,which was significantly higher than 84.24%of the conventional group(P<0.05).One year after surgery,the incidence of urinary incontinence in the minimally invasive group was 5.06%,which was significantly lower than 18.42%of the conventional group,and the pregnancy rate was 56.96%,which was significantly higher than 38.15%of the conventional group,with statistically significant differences(P<0.05).Conclusion Laparoscopic surgery for EMT can optimize surgical procedures,improve efficacy,inhibit the release of serum VCAM-1 and PAI-1,reduce the risk of postoperative urinary incontinence,promote ovarian function recovery,and better improve pregnancy outcomes and patients’prognosis.