良性前列腺增生症三种术式对机体应激影响的比较

Effects of three procedures for benign prostatic hyperplasia on stress responses:A comparison study

目的 探讨三种术式治疗良性前列腺增生症所致创伤对应激性神经内分泌免疫反应的影响及其临床意义。 方法 分析经尿道前列腺电切除术 (Ⅰ组 )、耻骨上前列腺摘除术 (Ⅱ组 )和耻骨后前列腺摘除术 (Ⅲ组 )各 2 0例手术前后血清白细胞介素 - 6 (IL - 6 )、皮质醇浓度及T细胞亚群的变化特点。 结果 ①三种术式患者术后 3hIL - 6含量均显著升高 ,Ⅱ、Ⅲ组明显高于Ⅰ组 (P <0 0 5 )。Ⅱ、Ⅲ组患者术后 3h皮质醇含量显著升高 (P <0 0 1) ,而Ⅰ组变化不明显 (P >0 0 5 )。Ⅱ、Ⅲ组患者术后 2dCD4+ /CD8+ 比值显著下降 (P <0 0 1)且明显低于Ⅰ组 (P <0 0 5 ) ,Ⅰ组术后T细胞亚群无明显变化。④ 3组患者术后 3h皮质醇、IL - 6含量均与手术时间及术中失血量显著相关 (r =0 5 1～ 0 .80 ,P <0 0 5 )。 结论 开放手术机体应激反应程度高于内镜手术 ,缩短手术时间、减少术中失血量是减轻有害应激的有效方法。

Objective To investigate the effects of three procedures for benign prostatic hyperplasia (BPH) on neuroendocrine and immune responses and its clinical significance. Methods Patients were divided into three groups with 20 patients in each group: the Group Ⅰreceived the transuretheral resection of prostate (TURP), the Group Ⅱ received the suprapubic transvesical prostatectomy (SPP) and the Group Ⅲ underwent the retropubic prevesical prostatectomy (RPP). The pre- and post- operative serum concentrations of Interleukin-6 (IL-6) and cortisol as well as changes of T-cell subgroups in the three groups were analyzed , respectively. Results Serum IL-6 concentrations remarkably increased at the third postoperative hour in patients of all the three groups, but those in Group Ⅱ and Group Ⅲ were significantly higher than those in Group Ⅰ( P <0 05). Cortisol levels increased significantly at the third postoperative hour in Group Ⅱ and Group Ⅲ ( P <0 01), but those in Group Ⅰkept unremarkable changes ( P >0 05). The ratio of CD 4 +/CD 8 + decreased markedly on the second postoperative day in Group Ⅱ and Group Ⅲ ( P <0 05), significantly lower than those in Group Ⅰ ( P <0 05). There were no significant changes in T-cell subgroups in Group Ⅰ postoperatively. The serum cortisol and IL-6 levels at the third postoperative hour in all the groups closely correlated with the operation time and the intraoperative blood loss (0 51<r<0 80, P <0 01). Conclusions Stress responses in open surgery have a greater degree than those in endoscopic surgery. Shortening operation time and minimizing intraoperative blood loss are effective measures to relieve harmful stress responses.