不同腹腔镜术式治疗子宫肌瘤的效果及对疼痛、应激代谢、宫颈局部微循环的影响  

Effects of Different Laparoscopic Surgical Methods on Uterine Fibroids and Their Effects on Pain,Stress Metabolism and Local Microcirculation of Cervix

作　　者：刘海艳 张洁[2] 陈秀琴[3] LIU Haiyan;ZHANG Jie;CHEN Xiuqin(Department of Gynecology,the Affiliated Hospital of Henan Academy of Medical Sciences,Zhengzhou 450000,China;Department of Obstetrics and Gynecology,Zhengzhou First People’s Hospital,Zhengzhou 450000,China;Department of Gynecology,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省医药科学研究院附属医院妇科,河南郑州450000 [2]郑州市第一人民医院妇产科,河南郑州450000 [3]郑州大学第五附属医院妇科,河南郑州450000

出　　处：《河南医学研究》2022年第15期2755-2758,共4页Henan Medical Research

摘　　要：目的对比不同腹腔镜术式治疗子宫肌瘤患者的效果。方法选取河南省医药科学研究院附属医院2019年3月至2021年10月收治的92例子宫肌瘤患者进行前瞻性随机平行对照研究,按随机数字表法分成A组(46例)、B组(46例)。B组接受经脐单孔腹腔镜子宫肌瘤剔除术(SPLM)治疗,A组接受多孔腹腔镜子宫肌瘤剔除术(MPLM)治疗。对比两组围手术期指标、术后1和3 d视觉模拟评分法(VAS)评分、手术前后卵巢储备功能指标[雌二醇(E_(2))、黄体生成素(LH)、卵泡刺激素(FSH)]、宫颈局部微循环指标(毛细血管管径、血流灌注)、应激代谢指标[皮质醇(COR)、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))]水平。结果A组术中失血量较B组少,术后排气及住院时长较B组短,手术时长较B组长(P<0.05),A组术后1、3 d VAS评分较B组低(P<0.05);术后1、3个月A组血清E_(2)、LH、FSH水平较B组高(P<0.05);A组术后7 d毛细血管管径较B组长,血流灌注较B组快(P<0.05);术后1 d A组血清COR、FT_(3)、FT_(4)水平较B组低(P<0.05);术后3 d两组血清COR、FT_(3)、FT_(4)水平对比,差异无统计学意义(P>0.05)。结论相较于传统SPLM治疗子宫肌瘤患者,应用MPLM治疗在减少术中失血量、促进术后机体恢复、减轻术后疼痛感、提高宫颈局部微循环方面更具优势,且对机体应激代谢、卵巢储备功能产生影响更小,但手术时长略长。Objective To compare the effects of different laparoscopic surgery in the treatment of uterine fibroids.Methods A total of 92 patients with uterine fibroids from March 2019 to October 2021 in the Affiliated Hospital of Henan Academy of Medical Sciences were selected for a prospective randomized parallel controlled study.They were divided into group A(46 cases)and group B(46 cases)according to the random number table method.Group B received transumbilical single-port laparoscopic myomectomy(SPLM),and group A received multiport laparoscopic myomectomy(MPLM).The perioperative indicators,visual analogue scale(VAS)scores at 1 day and 3 days after surgery,ovarian reserve function indicators[estradiol(E_(2)),luteinizing hormone(LH),follicle-stimulating hormone(FSH)],cervical local microcirculation index(capillary diameter,blood perfusion),stress metabolism index[cortisol(COR),free triiodothyronine(FT_(3)),free thyroxine(FT_(4))]levels before and after surgery were compared between the two groups.Results The intraoperative blood loss of group A was less than that of group B,the postoperative exhaust gas and hospitalization time were shorter than those of group B,and the operation time was longer than that of group B(P<0.05).The VAS score of group A was lower than that of group B at 1 and 3 days after operation(P<0.05).The serum E_(2),LH and FSH levels in group A were higher than those in group B at 1 month and 3 months after operation(P<0.05).The capillary diameter of group A was longer than that of group B at 7 days after operation,and the blood flow perfusion was faster than that of group B(P<0.05).The serum levels of COR,FT_(3) and FT_(4) in group A were lower than those in group B at 1 day after operation(P<0.05).There was no statistical difference in serum COR,FT_(3) and FT_(4) levels between the two groups at 3 days after operation(P>0.05).Conclusion Compared with the traditional SPLM in the treatment of uterine fibroids,the application of MPLM has more advantages in reducing intraoperative blood loss,promoting pos

关 键 词：子宫肌瘤 应激代谢 宫颈局部微循环 

分 类 号：R737.33[医药卫生—肿瘤]