腹腔镜与经腹子宫肌瘤剔除术对患者手术应激反应的影响比较

Influence comparison of laparoscopic myomectomy and abdominal myomectomy on stress response of patients

目的比较腹腔镜与经腹子宫肌瘤剔除术对患者手术应激反应的影响。方法选择2013年1月—2015年1月于四川省司法警官总医院妇科行子宫肌瘤剔除术的患者106例,按随机数字表分为经腹子宫肌瘤剔除术组(A组)53例与腹腔镜子宫肌瘤剔除术组(B组)53例。术后3d检测去甲肾上腺素(NE)、肾上腺素(E)、多巴胺(DA)、皮质醇(COS)水平及炎性因子(肿瘤坏死因子α、白介素-1)水平。结果两组患者治疗前NE、E、DA、COS水平比较,差异无统计学意义(P>0.05);治疗后B组NE、E、DA、COS水平低于A组,差异有统计学意义(P<0.05)。治疗前两组患者肿瘤坏死因子α、白介素-1水平比较,差异无统计学意义(P>0.05);治疗后B组肿瘤坏死因子α、白介素-1水平低于A组,差异有统计学意义(P<0.05)。结论腹腔镜子宫肌瘤剔除术较经腹子宫肌瘤剔除术手术创伤小,减少了手术导致的血管应激反应和术后炎性反应,是一种安全可行的治疗方式,但仍存在局限性,无法完全替代经腹子宫肌瘤剔除术,应综合考虑后实施。

Objective To compare the influence of laparoscopic myomectomy and abdominal myomectomy on stress response of patients. Methods A total of 106 patients treated with myomectomy in Sichuan Judicial Police General Hospital from January 2013 to January 2015 were selected,they were randomly divided into 53 cases of the abdominal myomectomy group( A group) and 53 cases of laparoscopic myomectomy group( B group). The fasting blood were extracted for detecting norepinephrine( NE),epinephrine( E),dopamine( DA),cortisol( COS) and inflammatory factor( tumor necrosis factor α,interleukin 1) after operation 3d. Results The NE,E,DA,COS between the two groups showed no significant difference before treatment( P > 0. 05),after treatment the NE,E,DA,COS of B group were lower than A group( P < 0. 05). Tumor necrosis factor α,interleukin 1 between the two groups showed no significant difference before treatment( P > 0. 05),after treatment tumor necrosis factor α,interleukin 1 of B group were lower than A group( P < 0. 05). Conclusion Comparing with abdominal myomectomy,the laparoscopic myomectomy can reduce surgical trauma,reduce vascular stress response and postoperative inflammatory reaction for surgery,it is a safe and feasible treatment,but there are still limitations,can not completely replace the abdominal myomectomy,so should be used after the comprehensive assessment.