悬吊式和气腹式腹腔镜子宫肌瘤剔除术的疗效观察和细胞免疫的对比分析  

Comparisons of Curative Effect and Immune Response Between Suspended Gasless and Conventional Laparoscopic Myomectomy

作　　者：张丽云[1] 杨金铭[1] 王健[1] 吴聪哲[1] 房秋霞[1] 

机构地区：[1]唐山市协和医院妇产科,河北唐山063000

出　　处：《标记免疫分析与临床》2016年第11期1306-1309,共4页Labeled Immunoassays and Clinical Medicine

基　　金：河北省卫生厅科研基金项目(20150998)

摘　　要：目的比较悬吊式与气腹式腹腔镜子宫肌瘤剔除的临床疗效和对淋巴细胞免疫的影响。方法回顾性分析2012年10月至2014年10月唐山市协和医院妇产科子宫肌瘤患者150例,按不同术式分悬吊式腹腔镜组75例,气腹式腹腔镜组75例。分析比较手术时间、血气分析、术中出血量、肛门排气时间、剔除肌瘤数目、术后腹腔引流量;采用EPICS XL流式细胞仪检测两组术前、术后1、5天外周血淋巴细胞亚群的变化。结果悬吊组手术时间、术中出血量、术后腹腔引流量、二氧化碳分压（PCO2）和碱剩余（BE）低于气腹组（t=4.953-8.167,P〈0.05）;剔除肌瘤数目多于气腹组（t=5.927,P〈0.05）。术后1天,两组CD3、CD4、CD8、CD4/CD8低于术前及术后第5天。术后第5天悬吊组恢复正常,而气腹组CD3、CD4仍低于术前水平（t=2.676-4.621,P〈0.05）;两组间比较,气腹组术后第1天CD3、CD4、CD8、CD4/CD8均低于悬吊组,差异有统计学意义（t=2.624-3.736,P〈0.05）。结论悬吊式腹腔镜优于气腹式腹腔镜,避免CO2对机体的影响,保护机体的细胞免疫功能。Objective To compare the curative effect and the effect on lymphocyte subtype of myomectomy performed by gasless laparoscopy and traditional laparoscopy. Methods A retrospective analysis was made on clinical data of 75 suspended gasless laparoscopy cases（ gasless group） and 75 cases of traditional laparoscopy（ traditional group） from October 2012 to October 2014. The operative time,intraoperative blood gas analysis,the amount of blood loss,exsufflation and discharge,base excess（ BE）,the number of removed myomas and drainage volume were all compared. The types of lymphocytes before operation,day one and day five after surgery were observed. Results The operation time,intra-operative blood loss,drainage volume,PCO2 and BE in gasless group were lower than those in the traditional group（ t = 4. 953-8. 167,P 〈 0. 05）. However,the number of removed myomas was higher than that in the traditional group（ t= 5. 927,P 〈 0. 05）. On Day one,CD3,CD4,CD8 and CD4 / CD8 in the two groups were lower than those before surgery and Day five. After Day five,CD3 and CD4 were still less than preoperative in the traditional group（ t = 2. 676-4. 621,P 〈 0. 05）. CD3,CD4,CD8 and CD4 / CD8 in traditional group were lower on day one post surgery than those in the gasless group. Conclusion It suggests that gasless laparoscopy has more advantages than conventional laparoscopy. Suspended laparoscopy can avoid CO2 pneumoperitoneum and protect the body ＇s cellular immune function.

关 键 词：悬吊式腹腔镜 气腹式腹腔镜 子宫肌瘤切除术 淋巴细胞亚群 

分 类 号：R737.33[医药卫生—肿瘤]