腹腔镜下子宫切除术对患者术后免疫功能及近期预后的影响  

Laparoscopic Hysterectomy on Immune Function and Long-term Postoperative Prognosis

作　　者：王宏[1] 张志强[1] 李孟慧[1] 桑翠琴[1] 

机构地区：[1]首都医科大学附属北京朝阳医院妇产科,北京100020

出　　处：《医学综述》2016年第11期2184-2187,共4页Medical Recapitulate

摘　　要：目的研究腹腔镜下子宫切除术对患者术后免疫功能及近期预后影响。方法选取2014年2月至2015年2月首都医科大学附属北京朝阳医院收治的88例需行子宫切除术的患者,按照随机数字表法将所有研究对象分为观察组和对照组,各44例。对照组行开腹手术治疗,观察组行腹腔镜下全子宫切除术。比较两组患者手术前后外周血免疫球蛋白水平、外周血补体、外周血T淋巴细胞亚群变化。比较两组患者术后镇痛和并发症发生情况。结果手术后,两组患者的Ig M、Ig A均没有明显的变化(P>0.05),观察组患者的Ig G水平[(10.21±1.67)g/L]较手术前[(13.12±1.89)g/L]下降,但明显高于对照组[(9.01±1.87)g/L](P<0.05);手术后,观察组患者的C4、外周血T淋巴细胞亚群无明显变化(P>0.05),观察组患者C3[(1.11±0.17)g/L、C4(0.16±0.02)g/L、CD+3(68.75±9.65)%、CD+4(40.41±8.06)%、CD+8(27.98±7.46)%、CD+4/CD+8比值(1.81±0.58)%]高于对照组[(0.82±0.16)g/L、(0.10±0.01)g/L、(58.93±8.56)%、(32.58±8.25)%、(24.21±9.42)%,(1.47±0.49)](P<0.05);观察组患者术后镇痛率和并发症发生率显著低于对照组[11.36%(5/44)比29.55%(13/44)、2.27%(1/44)比13.64%(6/44)],差异有统计学意义(P<0.05)。结论腹腔镜下子宫切除术能促进患者的免疫功能恢复,并发症发生率较低,有利于患者预后,值得进一步推广使用。Objective To study the effect of laparoscopic hysterectomy on immune function and shortterm postoperative prognosis. Methods 88 patients needed hysterectomy admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from February 2014 to February 2015 were divided into observation group and the control group according to a random number table method,each group had 44 patients.The control group underwent open surgery,observation group underwent laparoscopic hysterectomy. The peripheral blood immunoglobulin levels,peripheral complement of peripheral blood T lymphocyte subsets before and after surgery change of two groups of patients were compared. Postoperative pain and complications were compared. Results After surgery,Ig M,Ig A of two groups were no significant change（ P〈0. 05）, postoperative Ig G levels of observation group was significantly decreased than before surgery[（ 10. 21 ±1. 67） g/L][（ 13. 12 ± 1. 89） g/L],and higher than the control group [（ 9. 01 ± 1. 87） g/L]（ P〈0. 05）. After surgery,observation group C4,peripheral blood T lymphocyte subsets,no significant change（ P〈0. 05）. After surgery,the observation group C3（ 1. 11 ± 0. 17） g/L,C4（ 0. 16 ± 0. 02） g/L、CD＋3（ 68. 75 ± 9. 65） %,CD＋4（ 40. 41 ± 8. 06） %,CD＋8（ 27. 98 ± 7. 46） %,CD＋4/ CD＋8ratio（ 1. 81 ±0. 58） %] were significantly higher than in the control group [（ 0. 82 ± 0. 16） g / L,（ 0. 10 ± 0. 01 g / L）,（ 58. 93 ± 8. 56） %,（ 32. 58 ± 8. 25） %,（ 24. 21 ± 9. 42） %,（ 1. 47 ± 0. 49） ]（ P〈0. 05）. Postoperative analgesia rate of the observation group [11. 36%（ 5 /44） ] and the incidence occurrence [2. 27%（ 1 /44） ]was significantly lower than the control group[29. 55%（ 13 /44）,13. 64%（ 6 /44） ]（ P〈0. 05）.Conclusions The recovery of immune function in patients is better through laparoscopic hysterectomy than abdominal hysterectomy with low complication rate. It is worth further to promote.

关 键 词：腹腔镜下子宫切除术 免疫功能 近期预后 

分 类 号：R713[医药卫生—妇产科学]