摘要
目的：探讨腹腔镜子宫切除术与开腹子宫切除术对患者卵巢血流动力学的影响。方法选取行子宫切除术的患者132例，其中接受腹腔镜子宫切除术76例（腹腔镜组），开腹子宫切除术56例（开腹组），观察两组术前和术后卵巢动脉血流动力学指标、T 细胞亚群及血清激素指标。结果观察组和对照组术后48 h 搏动指数（PI）、阻力指数（RI）、收缩期血流速最大值（Vmax）和舒张末期血流速最小值（Vmin）有所降低（P 〈0.05），术后2周有所上升（P 〈0．05）；观察组术后48 h 和术后2周 PI、RI、Vmax 和 Vmin 分别为（1．17±0.16）和（1．30±0．14）、（0．66±0．11）和（0．70±0．06）、（11．80±3．10）m／s 和（12．17±3．26）m／s、（3．01±0．19）m／s 和（2．98±0．20）m／s，均高于对照组（t ＝-10．637和-7．609，-5．880和-2．583，-5．084和-3．271，-13．660和-4．826，均 P 〈0．05）；观察组和对照组术后 CD4^＋和 CD3^＋ T 细胞有所升高（P 〈0．05）， CD8^＋ T 细胞有所降低（P 〈0．05）；观察组术后48 h 和术后2周 CD4^＋和 CD3^＋ T 细胞分别为（43．50±3．50）％和（47．20±3.16）％、（73．50±6．17）％和（80．06±9．20）％，均高于对照组（t ＝-6．859和-5．599，-5．515和-4．853，均 P 〈0．05），而 CD ＋8 T 细胞分别为（37．52±5．10）％和（34．10±3．20）％，低于对照组（t ＝3．007和3．214，均P 〈0．05）；观察组和对照组术后雌二醇（E2）明显降低（P 〈0．05），卵泡刺激素（FSH）明显升高（P 〈0．05）；观察组术后1个月和3个月 E2明显低于对照组（P 〈0．05），FSH 明显高于对照组（P 〈0．05）。结论腹腔镜子宫切除术对患者卵巢血流动力学、卵巢功能和免疫功能影响小，值得临床推广。
Objective To investigate the effect of laparoscopic hysterectomy and open hysterectomy on ovarian hemodynamics.Methods Selected 132 patients who underwent hysterectomy,among them,76 cases （laparoscopic group）underwent laparoscopic hysterectomy,56 cases（open group）underwent open hysterectomy.The preoperative and postoperative ovarian artery hemodynamic parameters,T cell subsets and serum hormone index of the two groups were observed.Results In the observation group and the control group postoperative 48h,the pulsatility index（PI）, resistance index （RI）,systolic blood flow velocity maximum （Vmax）and diastolic stage blood velocity minimum （Vmin）decreased（all P 〈0.05）,which of postoperative 2 weeks increased（all P 〈0.05）.The RI,Vmax and PI in the observation group postoperative 48h and 2 weeks were （1.17 ±0.16）and （1.30 ±0.14）,（0.66 ±0.11）and （0.70 ±0.06）,（11.80 ±3.10）m/s and （12.17 ±3.26）m/s,（3.01 ±0.19）m/s and （2.98 ±0.20）m/s,which were all higher than those in the control group（t =-10.637 and -7.609,-5.880 and -2.583,-5.084 and -3.271,-13.660 and -4.826,all P 〈0.05）.The CD4^＋ and CD3^＋ T cells levels of the observation group and control group postoperation were increased（all P 〈0.05）,and the CD8^＋ T cells levels were decreased（all P 〈0.05）.The CD ＋4 and CD3^＋ T cells levels of the observation group postoperative 48h and 2 weeks were （43.50 ±3.50）% and （47.20 ±3.16）%, （73.50 ±6.17）% and （80.06 ±9.20）%,which were higher than those in the control group（t =-6.859 and -5.599,-5.515 and -4.853,all P 〈0.05）,while the CD ＋8 T cells were （37.52 ±5.10）% and （34.10 ±3.20）%,which were lower than those in the control group（t =3.007 and 3.214,all P 〈0.05 ）.The estradiol（E2 ）levels of the observation group and control group were significantly decreased（all P 〈0.05）,follicle stimulating hormone（FSH） levels were significantly increased（all P 〈0.05）.The E2 levels of the observation group postoperative 1 month and 3 months were significantly lower than those of the control group（all P 〈0.05）,FSH levels were significantly higher than those of the control group （P 〈0.05）.Conclusion The effect of laparoscopic hysterectomy on ovarian hemodynamics,ovarian function and immune function is small,and it is worth to be popularized in clinical application.
作者
张璞
任诗帆
舒楚强
Zhang Pu Ren Shifan Shu Chuqiang(Department of Gynecology, the Maternal and Child Health Care Hospital of Hunan Province, Changsha, Hunan 410008, China)
出处
《中国基层医药》
CAS
2017年第5期693-697,共5页
Chinese Journal of Primary Medicine and Pharmacy
