腹腔镜下微创手术治疗特殊部位子宫肌瘤的效果及对卵巢内分泌功能的影响
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摘要
目的研究腹腔镜下微创手术治疗特殊部位子宫肌瘤的效果及对卵巢内分泌功能的影响。方法选择该院收治的子宫肌瘤患者104例,对照组(52例)采取开腹子宫肌瘤切除术,观察组(52例)行腹腔镜下子宫肌瘤切除术。应用ELISA法检测两组肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1、IL-6及心肌细胞P物质(SP)水平;应用放射免疫分析法(RIA)检测雌二醇(E2)、卵泡刺激素(FSH)、促黄体生成素(LH)水平。记录患者随访2年的情况。结果观察组患者所用手术时间明显长于对照组(P<0.01),观察组留置尿管时间、术中出血量、术后排气和排便时间、术后留置引流管时间、住院时间,以及术后3d的TNF-α、IL-1及IL-6水平均明显低于对照组(P<0.05)。术后,与对照组相比,观察组患者血清中SP、FSH和LH水平明显降低(P<0.05),E2水平明显升高(P<0.05)。两组患者手术中均未发生血管及脏器损伤。结论经腹腔镜下手术切除治疗特殊部位子宫肌瘤手术创伤小,减少手术导致机体的应激反应与疼痛反应,可加快卵巢分泌功能的恢复,利于术后康复。
Objective To study the effect of laparoscopic minimally invasive surgery in the treatment of uterine fibroids at privileged sites and its influence on ovarian secretion function.Methods One hundred and four patients with uterine fibroids in this hospital were selected.The control group(52 cases)adopted laparotomic hysteromyomectomy,and the observation group(52 cases)conducted the laparoscopic hysteromyomectomy.The levels of tumor necrosis factor(TNF)-α,interleukin-1(IL)-1,IL-6 and cardiomyocyte substance P(SP)were determined by enzyme-linked immunosorbent assay(ELISA).The radioimmunoassay(RIA)was used to determine the changes of estradiol(E2),follicle-stimulating hormone(FSH)and luteinizing hormone(LH).The follow-up conditions within 2 years were recorded.Results The operative time in the observation group was significantly longer than that in the control group(P<0.01),but the indwelling urine catheter time,intraoperative blood loss volume,postoperative exhaust defecation time,postoperative indwelling drainage tube time and hospital stay in the observation group were significantly lower than those in the control group(P<0.05).The levels of TNF-α,IL-1 and IL-6 on postoperative 3 din the observation group were significantly lower than those in the control group(P<0.05).Compared with control group,the serum SP level and levels of FSH and LH after operation in the observation group were significantly decreased(P<0.05),while the level of E2 in the observation group was significantly increased(P<0.05).There was no occurrence of complications of visceral and vascular injury in the two groups.Conclusion Laparoscopic uterine fibroids resection at privileged sites has less trauma,reduces the stress inflammatory response caused by operation,accelerates the recovery of ovarian secretion function and is beneficial to postoperative rehabilitation.
Objective To study the effect of laparoscopic minimally invasive surgery in the treatment of uterine fibroids at privileged sites and its influence on ovarian secretion function.Methods One hundred and four patients with uterine fibroids in this hospital were selected.The control group(52 cases)adopted laparotomic hysteromyomectomy,and the observation group(52 cases)conducted the laparoscopic hysteromyomectomy.The levels of tumor necrosis factor(TNF)-α,interleukin-1(IL)-1,IL-6 and cardiomyocyte substance P(SP)were determined by enzyme-linked immunosorbent assay(ELISA).The radioimmunoassay(RIA)was used to determine the changes of estradiol(E2),follicle-stimulating hormone(FSH)and luteinizing hormone(LH).The follow-up conditions within 2 years were recorded.Results The operative time in the observation group was significantly longer than that in the control group(P<0.01),but the indwelling urine catheter time,intraoperative blood loss volume,postoperative exhaust defecation time,postoperative indwelling drainage tube time and hospital stay in the observation group were significantly lower than those in the control group(P<0.05).The levels of TNF-α,IL-1 and IL-6 on postoperative 3 din the observation group were significantly lower than those in the control group(P<0.05).Compared with control group,the serum SP level and levels of FSH and LH after operation in the observation group were significantly decreased(P<0.05),while the level of E2 in the observation group was significantly increased(P<0.05).There was no occurrence of complications of visceral and vascular injury in the two groups.Conclusion Laparoscopic uterine fibroids resection at privileged sites has less trauma,reduces the stress inflammatory response caused by operation,accelerates the recovery of ovarian secretion function and is beneficial to postoperative rehabilitation.
引文
[1]郝敏,程科研,赵卫红.特殊部位子宫肌瘤诊治策略[J].中国实用妇科与产科杂志,2016,32(2):151-154.
[2]李兴媚,车立群,关郁,等.腹腔镜子宫肌瘤切除术与开腹子宫肌瘤切除术临床效果比较[J].中国妇幼保健,2015,30(21):3720-3722.
[3]李海宁,丁永慧,郭珊珊.腹腔镜下特殊部位子宫肌瘤剔除术的可行性分析[J].宁夏医学杂志,2015,37(9):802-804.
[4]姚霞,郝敏.手术治疗特殊部位子宫肌瘤82例临床分析[J/CD].中华腔镜外科杂志(电子版),2015,8(1):49-53.
[5]江一民,顾建钧,杜兆辉.浦东新区社区卫生服务卫技人员培训现状与需求分折[J].中华全科医学,2011,9(7):1096-1097.
[6]杜敏,陆静,邓玉艳.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[J].临床合理用药,2016,9(3):23-24.
[7] FAERSTEIN E,SZKLO M,ROSENSHEIN N B.Risk factors for uterine leiomyoma:apractice-based case-control studyⅡ.Atherogenic risk factors and potential sources of uterine irritation[J].Am J Epidemiol,2001,153(1):11-19.
[8]王瑞敏,侯懿.腹腔镜子宫肌瘤剔除术与传统开腹手术治疗子宫肌瘤的临床疗效比较[J].重庆医学,2014,43(7):852-853.
[9]杨春红,岳瑛.腹腔镜治疗子宫肌瘤的研究进展[J].中国妇幼保健,2013,28(10):1685-1687.
[10]喇端端,沈立裴,沈育红.妇科腹腔镜手术脏器及血管损伤并发症分析[J].上海交通大学学报(医学版),2006,26(12):1377-1380.
[11]KUBINOVA K,MARA M,NOVOTNA M,et al.Laparoscopic uterus sparing treatment of uterine fibroids[J].Ceska Gynekol,2012,77(4):326-330.
[12]IHLER F,PELZ S,COORS M,et al.Application of a TNF-alpha-inhibitor into the scala tympany after cochlear electrode insertion trauma in Guinea pigs:preliminary audiologic results[J].Int J Audiol,2014,53(11):810-816.
[13]蒋丽,白华,韦妙成,等.子宫肌瘤腹腔镜与开腹切除术围术期TNF-α、IL-6和IL-10的变化[J].中国妇幼保健,2011,26(21):3231-3233.
[14]VEENHOF A A,VLUG M S,MH V D P,et al.Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care:a randomized trial[J].Ann Surg,2012,255(2):216-221.
[2]李兴媚,车立群,关郁,等.腹腔镜子宫肌瘤切除术与开腹子宫肌瘤切除术临床效果比较[J].中国妇幼保健,2015,30(21):3720-3722.
[3]李海宁,丁永慧,郭珊珊.腹腔镜下特殊部位子宫肌瘤剔除术的可行性分析[J].宁夏医学杂志,2015,37(9):802-804.
[4]姚霞,郝敏.手术治疗特殊部位子宫肌瘤82例临床分析[J/CD].中华腔镜外科杂志(电子版),2015,8(1):49-53.
[5]江一民,顾建钧,杜兆辉.浦东新区社区卫生服务卫技人员培训现状与需求分折[J].中华全科医学,2011,9(7):1096-1097.
[6]杜敏,陆静,邓玉艳.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[J].临床合理用药,2016,9(3):23-24.
[7] FAERSTEIN E,SZKLO M,ROSENSHEIN N B.Risk factors for uterine leiomyoma:apractice-based case-control studyⅡ.Atherogenic risk factors and potential sources of uterine irritation[J].Am J Epidemiol,2001,153(1):11-19.
[8]王瑞敏,侯懿.腹腔镜子宫肌瘤剔除术与传统开腹手术治疗子宫肌瘤的临床疗效比较[J].重庆医学,2014,43(7):852-853.
[9]杨春红,岳瑛.腹腔镜治疗子宫肌瘤的研究进展[J].中国妇幼保健,2013,28(10):1685-1687.
[10]喇端端,沈立裴,沈育红.妇科腹腔镜手术脏器及血管损伤并发症分析[J].上海交通大学学报(医学版),2006,26(12):1377-1380.
[11]KUBINOVA K,MARA M,NOVOTNA M,et al.Laparoscopic uterus sparing treatment of uterine fibroids[J].Ceska Gynekol,2012,77(4):326-330.
[12]IHLER F,PELZ S,COORS M,et al.Application of a TNF-alpha-inhibitor into the scala tympany after cochlear electrode insertion trauma in Guinea pigs:preliminary audiologic results[J].Int J Audiol,2014,53(11):810-816.
[13]蒋丽,白华,韦妙成,等.子宫肌瘤腹腔镜与开腹切除术围术期TNF-α、IL-6和IL-10的变化[J].中国妇幼保健,2011,26(21):3231-3233.
[14]VEENHOF A A,VLUG M S,MH V D P,et al.Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care:a randomized trial[J].Ann Surg,2012,255(2):216-221.