腹腔镜下子宫次切术不同处理方式对免疫功能和肿瘤转移的影响  

Effects of different treatment modes during laparoscopic subtotal hysterectomy on immune function and tumor metastasis

作　　者：房明[1] 王龙平[1] 

机构地区：[1]句容市人民医院麻醉科,江苏句容212400

出　　处：《中国妇幼保健》2016年第17期3477-3480,共4页Maternal and Child Health Care of China

摘　　要：目的研究麻醉方法对腹腔镜下子宫次切术患者免疫功能和肿瘤转移的影响。方法选取80例行腹腔镜下子宫次全切除术患者作为研究对象。按随机数字表法分为观察组和对照组,观察组采用全凭静脉麻醉,对照组采用全麻联合硬膜外阻滞,观察两组患者术前(T0)、术毕(T1)、术后24 h(T2)、术后48 h(T3)的一般生理指标、T淋巴细胞亚群、免疫球蛋白水平、不良反应等情况。结果观察组与对照组的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、氧饱和度(Sp O_2)在术前(T0)、术毕(T1)、术后24 h(T2)、术后48 h(T3)各时点比较差异均无统计学意义(P>0.05);观察组和对照组CD3、CD4、CD8在T1、T2时点较T0时点降低,但观察组降低更明显(P<0.05);观察组和对照组免疫球蛋白指标Ig G、Ig A、Ig M在T0、T1、T2、T3各时点比较差异均无统计学意义(P>0.05);组内CRO-1、IP-10水平T1、T2时比T0时降低(P<0.05);观察组不良情况总发生率(7.50%)小于对照组(22.50%),差异具有统计学意义(P<0.05)。结论全凭静脉麻醉和全麻联合硬膜外阻滞麻醉均会对患者免疫功能产生抑制作用,但不会造成患者的肿瘤转移,临床上采取全凭静脉麻醉治疗效果更显著。Objective To research the effects of anesthetic methods during laparoscopic subtotal hysterectomy on immune function and tumor metastasis. Methods Eighty patients undergoing laparoseopic subtotal hysterectomy were selected as study object, then they were divided into observation group and control group according to random number table. The patients in observation group were treated by total intravenous anesthesia, while the patients in control group were treated by general anesthesia combined with epidural block. The general physiological indexes, T lymphocyte subgroups, immunoglobulin levels, adverse reactions before surgery （T0） , at the end of surgery （ T1 ）, at 24 hours after surgery （T2） , and at 48 hours after surgery （ T3 ） in the two groups were observed. Results There was no statistically significant difference in mean arterial pressure （MAP）, heart rate （HR）, respiratory rate （RR）, oxygen saturation （SpO2 ） at TO, T1, T2, and T3 time points between observation group and control group （P〉0. 05） . In the two groups, CD3, CIM, and CD8 levels at T1 and T2 time points were lower than those at TO time point, especially in observation group （ P〈0.05 ） . In the two groups, there was no statistically significant difference in IgG, IgA, and IgM at T0, T1, T2, and T3 time points between observation group and control group （ P〉0. 05 ） ; CRO- 1 and IP-10 levels at T1 and T2 time points were statistically significantly lower than those at TO time point （P〈0.05） . The total incidence rate of adverse reactions in observation group was 7. 50% , which was statistically significantly lower than that in control group （22. 50% ） （P〈0. 05） . Conclusion Both total intravenous anesthesia and general anesthesia combined with epidural block can inhibit immune func- tion of patients, but they will not cause tumor metastasis, the effect of total intravenous anesthesia is more significant compared with general anesthesia combined with epidural block.

关 键 词：麻醉方法 子宫次切术 免疫功能 肿瘤转移 

分 类 号：R713.4[医药卫生—妇产科学]