腹腔镜电凝及超声刀止血方式对腹腔镜全子宫切除术患者性激素近期卵巢功能及免疫功能的影响

Effects of Laparoscopic Unipolar and Bipolar Electrocautery and Harmonic Scalpel Hemostasis on Sex Hormones,Short-Term Ovarian Function,and Immune Function in Patients Undergoing Laparoscopic Total Hysterectomy

目的:分析腹腔镜下单、双极电凝及超声刀止血方式对行腹腔镜全子宫切除术患者性激素、近期卵巢功能及免疫功能的影响。方法:选取2020年10月至2023年12月本院收治行腹腔镜全子宫切除术患者105例,根据简单随机法分为单、双极电凝组(n=53)、超声刀组(n=52)。比较两组相关手术指标、性激素[黄体生成素(LH)、促卵泡素(FSH)、雌二醇(E2)]、卵巢功能[最大直径(MOD)、窦卵泡计数(AFC)、卵巢动脉收缩期峰值血流速度(PSV)]、免疫功能及并发症。结果:两组术中失血量比较,具有统计学差异(P<0.05)。术前两组LH、FSH及E2水平差异无统计学意义(P>0.05),术后,两组LH、FSH较术前升高,及E2水平均显著变化较术前降低,术后,单、双极电凝组LH、FSH、E2差值高于超声刀组(P<0.05)。术前两组MOD及PSV差异无统计学意义,对照组术前后AFC差异无统计学意义(P>0.05),术后,两组MOD、PSV较术前降低,术后,单、双极电凝组MOD、AFC及PSV差值高于超声刀组(P<0.05)。术前两组CD3^(+)、CD4^(+)、CD8^(+)水平差异无统计学意义(P>0.05),术后,两组CD3^(+)、CD4^(+)、CD8^(+)较术前降低,术后,单、双极电凝组CD3^(+)、CD4^(+)、CD8^(+)差值高于超声刀组(P<0.05)。超声刀组月经周期异常发生率低于单、双极电凝组(P<0.05)。结论:腹腔镜下单、双极电凝及超声刀止血方式对行腹腔镜全子宫切除术患者性激素、近期卵巢功能及免疫功能均有一定影响,但超声刀止血方式不同类型、规模的手术,需结合患者具体情况选择合适的止血方式。

Objective:To analyze the effects of laparoscopic unipolar and bipolar electrocautery and harmonic scalpel hemostasis on sex hormones,short-term ovarian function,and immune function in patients undergoing laparoscopic total hysterectomy.Methods:A total of 105 patients undergoing laparoscopic total hysterectomy in our hospital from October 2020 to December 2023 were selected and randomly divided into a unipolar and bipolar electrocautery group(n=53)and a harmonic scalpel group(n=52)using a simple random sampling method.The two groups were compared in terms of surgical indicators,sex hormones[luteinizing hormone(LH),follicle-stimulating hormone(FSH),estradiol(E2)],ovarian function[maximum diameter(MOD),antral follicle count(AFC),ovarian artery peak systolic blood flow velocity(PSV)],immune function,and complications.Results:There was a statistically significant difference in intraoperative blood loss between the two groups(P<0.05).There was no statistically significant difference in the preoperative levels of LH,FSH,and E2 between the two groups(P>0.05).Postoperatively,LH and FSH levels increased in both groups compared to preoperative levels,and E2 levels decreased significantly in both groups compared to preoperative levels.Postoperatively,the differences in LH,FSH,and E2 between the unipolar and bipolar electrocautery group and the harmonic scalpel group were greater than those in the harmonic scalpel group(P<0.05).There was no statistically significant difference in MOD and PSV between the two groups preoperatively,and there was no statistically significant difference in AFC between the control group pre-and postoperatively(P>0.05).Postoperatively,MOD and PSV decreased in both groups compared to preoperative levels.Postoperatively,the differences in MOD,AFC,and PSV between the unipolar and bipolar electrocautery group and the harmonic scalpel group were greater than those in the harmonic scalpel group(P<0.05).There was no statistically significant difference in the preoperative levels of CD3^(+),CD4^(+),and CD8^(+)between the two groups(P>0.05).Postoperatively,CD3^(+),CD4^(+),and CD8^(+)levels decreased in both groups compared to preoperative levels.Postoperatively,the differences in CD3^(+),CD4^(+),and CD8^(+)between the unipolar and bipolar electrocautery group and the harmonic scalpel group were greater than those in the harmonic scalpel group(P<0.05).The incidence of menstrual abnormalities in the harmonic scalpel group was lower than that in the unipolar and bipolar electrocautery group(P<0.05).Conclusion:Laparoscopic unipolar and bipolar electrocautery and harmonic scalpel hemostasis have certain effects on sex hormones,short-term ovarian function,and immune function in patients undergoing laparoscopic total hysterectomy.However,the choice of hemostasis method should be based on the specific patient and the type and scale of the surgery.