阴道自然腔道内镜手术对全子宫切除术患者免疫球蛋白及机体创伤应激水平的影响  

The effect of vaginal natural passage endoscopic surgery on immunoglobulin and body trauma stress levels in patients undergoing total hysterectomy

作　　者：张治洋 杜思颖 夏玉 李亚琴 ZHANG Zhiyang;DU Siying;XIA Yu;LI Yaqin(Department of Gynaecology,Ankang People's Hospital of Shaanxi Province,Ankang 725000,China)

机构地区：[1]陕西省安康市人民医院妇科,安康725000

出　　处：《国际免疫学杂志》2024年第4期396-401,共6页International Journal of Immunology

摘　　要：目的分析阴道自然腔道内镜手术(transvaginal natural orifice transluminal endoscopic surgery, vNOTES)对全子宫切除术患者免疫球蛋白(immunoglobulin, Ig)及机体创伤应激水平的影响。方法选取2021年1月至2023年1月在安康市人民医院接受全子宫切除术的患者120例, 随机分为vNOTES组和经脐单孔腹腔镜手术(laparoendoscopic single-site surgery, LESS)组, 每组患者均60例。比较两组患者临床指标, 术后3 d及2个月的切口美容满意度评分及术前和术后3 d的G、IgA、IgM、皮质醇(cortisol, Cor)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)、白细胞介素-6(interleukin-6, IL-6)水平, 同时比较两组患者并发症发生率。结果 vNOTES组患者手术时间、术中出血量、术后肛门排气时间、术后24 h VAS评分均低于LESS组[min:(79.32±9.66)比(88.62±10.24);mL:(7.57±1.22)比(9.68±1.71);h:(9.65±1.32)比(16.11±2.33);分:(2.75±0.42)比(3.62±0.56), t值分别为5.12、7.78、18.69、9.63, P值均<0.05];两组患者术后3 d切口美容满意度评分比较差异无统计学意义[分:(7.87±0.71)比(7.69±0.73), t=1.37, P>0.05], 但术后2个月vNOTES组患者切口美容满意度评分高于LESS组[分:(9.47±1.49)比(8.59±1.02), t=3.78, P<0.05];术后3 d两组患者IgG、IgA、IgM水平均较术前下降, 但vNOTES组IgG、IgA、IgM水平高于LESS组[g/L:(11.31±1.92)比(10.48±1.51);(1.86±0.33)比(1.64±0.28);(1.31±0.26)比(1.12±0.21), t值分别为2.63、3.94、4.40, P值均<0.05];术后3d两组Cor、TNF-α、IL-6水平较术前上升, 但vNOTES组Cor、TNF-α、IL-6水平低于LESS组[μg/L:(147.36±21.31)比(165.43±22.21);ng/L:(18.55±3.02)比(25.32±4.13);mmol/L:(44.96±7.35)比(55.13±9.19), t值分别为4.55、10.25、6.69, P值均<0.05];两组并发症总发生率比较差异无统计学意义(χ^(2)=0.70, P>0.05)。结论 vNOTES和LESS均安全有效, 但vNOTES可缩短手术时间、肛门排气时间, 减少术中出血量和术后疼痛, 且创伤小, 对免疫球蛋白和Objective To analysis the effects of transvaginal natural origin transvaginal endoscopic surgery(vNOTES)on immunoglobulin(Ig)levels and traumatic stress levels in patients undergoing total hysterectomy.Methods A total of 120 patients who underwent total hysterectomy in Ankang People's Hospital were randomly divided into the vNOTES group and the laparoscopic single site surgery(LESS)group from January 2021 to January 2023,with 60 patients in each group.The clinical indexes of patients were compared,aesthetic satisfaction scores of incision 3 days and 2 months after surgery,Ig G,IgA,IgM,cortisol(Cor)before and after surgery,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)levels,the incidence of complications between the two groups were compared.Results Operative time,intraoperative blood loss,postoperative anal exhaust time and 24 h VAS score in vNOTES group were all lower than those in LESS group[min:(79.32±9.66)vs(88.62±10.24);mL:(7.57±1.22)vs(9.68±1.71);h:(9.65±1.32)vs(16.11±2.33);score:(2.75±0.42)vs(3.62±0.56),t values are 5.12,7.78,18.69,9.63,respectively,all P values<0.05];There was no significant difference in the satisfaction scores of postoperative 3D incision beauty between the two groups[score:(7.87±0.71)vs(7.69±0.73),t=1.37,P>0.05],But after 2 months of surgery,the satisfaction score of incision beauty in the vNOTES group was higher than that in the LESS group[score:(9.47±1.49)vs(8.59±1.02),t=3.78,P<0.05];Three days after surgery,the levels of IgG,IgA,and IgM in both groups significantly decreased compared to preoperative levels,but the vNOTES group had higher levels of IgG,IgA,and IgM than the LESS group[g/L:(11.31±1.92)vs(10.48±1.51);(1.86±0.33)vs(1.64±0.28);(1.31±0.26)vs(1.12±0.21),t values are 2.63,3.94,4.40,respectively,all P values<0.05];Three days after surgery,two groups of Cor and TNF-α、IL-6 levels significantly increased compared to preoperative levels,but in the vNOTES group,Cor and TNF levels increased significantly-α、IL-6 levels are lower than those in the LESS g

关 键 词：全子宫切除术 阴道自然腔道内镜手术 脐单孔腹腔镜手术 创伤应激水平 免疫球蛋白 

分 类 号：R713.42[医药卫生—妇产科学]