vNOTES与开腹手术、腹腔镜手术对全子宫切除患者组织创伤、体液免疫及性功能影响的比较研究  

A comparative study of the effects of vNOTES with laparotomy,laparoscopic surgery on tissue trauma,humoral immunity and sexual function in patients with total hysterectomy

作　　者：朱静 孙滨州 邵长好 ZHU Jing;SUN Binzhou;SHAO Changhao(Qinhuangdao Maternal and Child Health Hospital,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市妇幼保健院,河北秦皇岛066000

出　　处：《东南大学学报（医学版）》2023年第2期312-317,共6页Journal of Southeast University(Medical Science Edition)

基　　金：秦皇岛市卫生健康委课题(202004A027)。

摘　　要：目的:比较阴道自然腔道内镜手术(vNOTES)与开腹手术、腹腔镜手术对全子宫切除患者组织创伤、体液免疫及性功能的影响。方法:选取2020年3月至2021年1月在我院行全子宫切除术患者157例,依据治疗方案不同分为A组(n=53)、B组(n=52)、C组(n=52),A组采用vNOTES,B组采用开腹手术,C组采用腹腔镜手术。比较3组手术有关指标,并发症,术前及术后1、3 d血清组织创伤指标[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)]、体液免疫指标[免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)],术前及术后3、6个月女性性功能量表(FSFI)、Oswestry功能障碍指数问卷表(ODI)评分。结果:A组术后肛门排气时间、住院时间较B组短,术后24 h VAS评分、术中出血量较B组低(P<0.05);A组术后1、3 d血清CRP、TNF-α、IL-1β水平低于B、C组,A、C组血清IgA、IgM、IgG水平高于B组,差异有统计学意义(P<0.05);3组术后3、6个月FSFI评分均较术前降低,但A、C组FSFI评分高于B组,差异有统计学意义(P<0.05);3组术后3、6个月ODI评分较术前下降,且A、C组低于B组(P<0.05);3组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:vNOTES可促进全子宫切除患者术后恢复,减轻术后疼痛程度,且机体组织创伤轻,免疫功能、性功能受损轻,效果优于开腹手术及腹腔镜手术。Objective:To study the effects of transvaginal natural lumen endoscopic surgery(vNOTES)compared with open surgery,laparoscopic surgery on tissue trauma,humoral immunity and sexual function in patients undergoing total hysterectomy.Methods:One hundred and fifty-seven patients who underwent total hysterectomy in our hospital from March 2020 to January 2021 were selected and divided into groups A(n=53),B(n=52),and C(n=52)according to different treatment plans.vNOTES was adopted in group A,open surgery in group B,and laparoscopic surgery in group C.The three groups were compared for surgery-related indexes,complications,preoperative,1 d and 3 d postoperative serum tissue trauma indexes[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)],humoral immune indexes[immunoglobulin A(IgA),immunoglobulin M(IgM),immunoglobulin G(IgG)],the female sexual function scale(FSFI),Oswestry dysfunction index questionnaire(ODI)scores at preoperate,3 and 6 months after surgery.Results:The postoperative anal venting time and hospital stay were shorter in group A than that in group B,and the 24-h postoperative VAS score and intraoperative bleeding were lower than that in group B(P<0.05);the serum CRP,TNF-α,and IL-1βlevels in group A were lower than those in groups C and B at 1 d and 3 d postoperatively,and the serum IgA,IgM,and IgG levels in groups A and C were higher than those in group B,with statistically significant differences(P<0.05).The FSFI scores at 3 and 6 months after surgery were lower than those before surgery,while the FSFI scores in groups A and C were higher than that in group B,the differences were statistically significant(P<0.05).The ODI scores at 3 and 6 months after surgery were lower than those before surgery,and the ODI scores in groups A and C were lower than that in group B(P<0.05).The differences of the incidence of postoperative complications in the 3 groups were not statistically significant(P>0.05).Conclusion:vNOTES can promote postoperative recovery and reduce the degree of post

关 键 词：经阴道自然腔道内镜手术 开腹手术 腹腔镜手术 全子宫切除 组织创伤 体液免疫 性功能 

分 类 号：R713.42[医药卫生—妇产科学]