腹腔镜全子宫切除术对子宫肌瘤患者机体氧化应激损伤及术后并发症的影响

doi:10.3877/cma.j.issn.1674-0785.2023.02.007

目的

探讨腹腔镜全子宫切除术对子宫肌瘤患者机体氧化应激损伤和术后并发症的影响。

方法

选择安徽理工大学第一附属医院妇科于2019年6月~2021年6月收治的子宫肌瘤患者102例，依据手术方法不同分为腹腔镜组与开腹组，各51例。腹腔镜组行腹腔镜全子宫切除术治疗，开腹组行开腹全子宫切除术治疗。比较2组手术指标和术后并发症情况，术前和术后3天机体氧化应激损伤指标，术前和术后3个月卵巢功能变化。

结果

腹腔镜组子宫肌瘤患者术中出血量少于开腹组，术后排气时间快于开腹组，手术时间短于开腹组（P＜0.05）。腹腔镜组子宫肌瘤患者术后并发症少于开腹组（P＜0.05）。2组术后3天子宫肌瘤患者氢氧根离子（OH^-）、超氧阴离子（O^-）、丙二醛（MDA）、皮质醇（Cor）水平较术前升高（P＜0.05）；腹腔镜组术后3天子宫肌瘤患者OH^-、O^-、MDA和Cor水平低于开腹组（P＜0.05）。2组术后3个月子宫肌瘤患者血清雌二醇（E₂）水平较术前降低，而促卵泡激素（FSH）、黄体生成素（LH）水平较术前升高（P＜0.05）；腹腔镜组术后3个月子宫肌瘤患者血清E₂水平高于开腹组，而FSH和LH水平低于开腹组（P＜0.05）。

结论

腹腔镜全子宫切除术对子宫肌瘤患者机体氧化应激损伤和卵巢功能影响小，且术后并发症少，安全性良好。

关键词: 腹腔镜全子宫切除术, 子宫肌瘤, 机体氧化应激损伤, 术后并发症

Objective

To investigate the effect of laparoscopic hysterectomy on oxidative stress injury and postoperative complications in patients with uterine fibroids.

Methods

A total of 102 patients with uterine fibroids admitted to the Department of Gynecology of the First Affiliated Hospital of Anhui University of Science and Technology from June 2019 to June 2021 were selected. According to the surgical method used, they were divided into a laparoscopic surgery group and open surgery group, with 51 cases in each group. Laparoscopic total hysterectomy was performed in the laparoscopic surgery group, and open total hysterectomy was performed in the open surgery group. The surgical indicators and postoperative complications, the oxidative stress damage indicators before and 3 days after the operation, and the changes in ovarian function before and 3 months after the operation were compared between the two groups.

Results

Intraoperative blood loss was significantly less, and time to postoperative exhaust time and operation time were significantly shorter in the laparoscopic surgery group than in the open surgery group (P＜0.05). Postoperative complications were significantly less in the open surgery group (P＜0.05). The levels of hydroxide ion (OH^-), superoxide anion (O^-), malondialdehyde (MDA), and cortisol (Cor) at 3 days after operation were higher those before operation in both groups (P＜0.05); the levels of OH^-, O^-, MDA, and Cor at 3 days after operation were significantly lower in the laparoscopic surgery group than in the open surgery group (P＜0.05). E₂ level at 3 months after operation was significantly lower and FSH and LH levels were significantly higher than those before operation in both groups (P＜0.05); serum E₂ level at 3 months after operation was significantly higher and the levels of FSH and LH were significantly lower in the laparoscopic surgery group than in the open surgery group (P＜0.05).

Conclusion

Laparoscopic total hysterectomy has little effect on oxidative stress damage and ovarian function in patients with uterine fibroids, and it has fewer postoperative complications with good safety.

Key words: Laparoscopic hysterectomy, Uterine fibroids, Oxidative stress injury, Postoperative complications

表1 2组子宫肌瘤患者手术指标比较（

x ¯

±s）

组别	例数	术中出血量（ml）	术后排气时间（h）	手术时间（min）
腹腔镜组	51	87.97±12.31	23.81±3.52	94.35±15.64
开腹组	51	138.71±18.29	30.95±4.13	110.08±12.78
t值		16.436	9.396	5.562
P值		＜0.001	＜0.001	＜0.001

表1 2组子宫肌瘤患者手术指标比较（

x ¯

±s）

组别	例数	术中出血量（ml）	术后排气时间（h）	手术时间（min）
腹腔镜组	51	87.97±12.31	23.81±3.52	94.35±15.64
开腹组	51	138.71±18.29	30.95±4.13	110.08±12.78
t值		16.436	9.396	5.562
P值		＜0.001	＜0.001	＜0.001

表2 2组子宫肌瘤患者术后并发症比较

组别	例数	皮下气肿	感染	输尿管损伤	腹部切口愈合不良	发生率（%）
腹腔镜组	51	1	1	1	0	5.88
开腹组	51	2	4	3	3	23.53
χ²值						6.331
P值						0.012

表2 2组子宫肌瘤患者术后并发症比较

组别	例数	皮下气肿	感染	输尿管损伤	腹部切口愈合不良	发生率（%）
腹腔镜组	51	1	1	1	0	5.88
开腹组	51	2	4	3	3	23.53
χ²值						6.331
P值						0.012

表3 2组子宫肌瘤患者机体氧化应激损伤指标比较（

x ¯

±s）

组别	例数	OH^-（U/L）				MDA（nmol/L）		Cor（μmol/L）
组别	例数	术前	术后3 d	术前	术后3 d	术前	术后3 d	术前	术后3 d
腹腔镜组	51	172.24±15.42	207.32±20.12^a	52.18±5.46	71.32±7.28^a	3.65±0.74	4.61±0.67^a	0.76±0.24	0.97±0.17^a
开腹组	51	170.91±18.94	289.95±17.31^a	51.32±6.17	98.95±4.78^a	3.71±0.95	6.14±0.81^a	0.74±0.21	1.35±0.26^a
t值		0.389	22.233	0.745	22.657	0.356	10.394	0.448	8.736
P值		0.698	＜0.001	0.458	＜0.001	0.723	＜0.001	0.655	＜0.001

表3 2组子宫肌瘤患者机体氧化应激损伤指标比较（

x ¯

±s）

组别	例数	OH^-（U/L）				MDA（nmol/L）		Cor（μmol/L）
组别	例数	术前	术后3 d	术前	术后3 d	术前	术后3 d	术前	术后3 d
腹腔镜组	51	172.24±15.42	207.32±20.12^a	52.18±5.46	71.32±7.28^a	3.65±0.74	4.61±0.67^a	0.76±0.24	0.97±0.17^a
开腹组	51	170.91±18.94	289.95±17.31^a	51.32±6.17	98.95±4.78^a	3.71±0.95	6.14±0.81^a	0.74±0.21	1.35±0.26^a
t值		0.389	22.233	0.745	22.657	0.356	10.394	0.448	8.736
P值		0.698	＜0.001	0.458	＜0.001	0.723	＜0.001	0.655	＜0.001

表4 2组子宫肌瘤患者卵巢功能变化比较（

x ¯

±s）

组别	例数	E₂（ng/L）
组别	例数	术前	术后3个月	术前	术后3个月	术前	术后3个月
腹腔镜组	51	112.36±5.45	103.21±6.24^a	8.54±1.23	9.83±1.08^a	9.30±1.39	10.45±1.08^a
开腹组	51	113.08±4.16	89.85±4.65^a	8.37±1.30	11.35±1.17^a	9.19±1.20	12.63±1.41^a
t值		0.750	12.722	0.678	6.817	0.428	8.766
P值		0.455	＜0.001	0.499	＜0.001	0.670	＜0.001

表4 2组子宫肌瘤患者卵巢功能变化比较（

x ¯

±s）

组别	例数	E₂（ng/L）
组别	例数	术前	术后3个月	术前	术后3个月	术前	术后3个月
腹腔镜组	51	112.36±5.45	103.21±6.24^a	8.54±1.23	9.83±1.08^a	9.30±1.39	10.45±1.08^a
开腹组	51	113.08±4.16	89.85±4.65^a	8.37±1.30	11.35±1.17^a	9.19±1.20	12.63±1.41^a
t值		0.750	12.722	0.678	6.817	0.428	8.766
P值		0.455	＜0.001	0.499	＜0.001	0.670	＜0.001

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Effect of laparoscopic total hysterectomy on oxidative stress injury and postoperative complications in patients with uterine fibroids

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Effect of laparoscopic total hysterectomy on oxidative stress injury and postoperative complications in patients with uterine fibroids