|
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-1β levels 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 postoperative pain in patients with total hysterectomy, with less trauma to the body tissues and less impairment of immune and sexual functions, with better results than open surgery and laparoscopic surgery. |
|
参考文献：
|
[1] 丁晓芳,周海燕.2种全子宫切除术对子宫肌瘤患者性功能和卵巢功能的影响对比[J].实用癌症杂志,2019,34(7):1124-1127.
[2] 黄灵霞,武静.不同子宫全切术式对卵巢功能影响[J].中国计划生育学杂志,2019,27(3):379-381.
[3] 韩璐.经阴道自然腔道内镜手术在妇科领域的应用发展现状与展望[J].中国实用妇科与产科杂志,2019,35(12):8-12.
[4] UCCELLA S,CAPOZZI V A,RICCO M,et al.Sexual Function following Laparoscopic versus Transvaginal Closure of the Vaginal Vault after Laparoscopic Hysterectomy:Secondary Analysis of a Randomized Trial by the Italian Society of Gynecological Endoscopy Using a Validated Questionnaire[J].J Minim Invasive Gynecol,2020,27(1):186-194.
[5] 杨琳,周敏.不同全子宫切除术的性功能及卵巢功能对比分析[J].中国性科学,2019,28(6):101-103.
[6] BACAL V,RANA U,MCISAAC D I,et al.Transversus abdominis plane block for post hysterectomy pain:a systematic review and meta-analysis[J].J Minim Invasive Gynecol,2019,26(1):40-52.
[7] 郑萍萍,朱骞.次全子宫切除术在子宫肌瘤患者中的应用效果[J].实用临床医药杂志,2019,23(14):96-98.
[8] 李宁建,华彬,章中良,等.双膦酸盐治疗加运动康复对绝经后妇女骨质疏松症的疗效研究[J].中国预防医学杂志,2019,20(11):1097-1100.
[9] 时红.腹腔镜下全子宫切除术处理复杂子宫肌瘤的可行性研究[J].中国妇幼保健,2019,34(9):2004-2007.
[10] 蔺明华.腹腔镜辅助阴式子宫切除术与开腹手术的临床效果比较[J].中国医刊,2018,53(6):626-628.
[11] 靳冬梅,伍东月,尹正芳,等.经阴道自然腔道内镜与经脐单孔腹腔镜全子宫切除术的比较[J].中国妇产科临床杂志,2021,22(1):70-71.
[12] 陈琳,郑莹,闵玲,等.vNOTES与TU-LESS行子宫全切除术的临床队列研究[J].中华妇产科杂志,2020,55(12):843-847.
[13] 李霞,杨蕾,王涛.腹腔镜子宫肌瘤手术对患者免疫、基质金属蛋白酶、血管新生及相关激素影响[J].中国计划生育学杂志,2019,27(10):1403-1406,1410.
[14] WIJK L,NILSSON K,LJUNGQVIST O.Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy:a randomised controlled study[J].Clin Nutr,2018,37(1):99-106.
[15] 邹晓燕,何君梅,刘玉蓉.腹式及阴式子宫切除术对机体应激反应及患者对卵巢储备的影响[J].中国妇产科临床杂志,2020,21(3):81-83.
[16] GAN W,YI Y,FU Y,et al.Fibrinogen and C-reactive protein score is a prognostic index for patients with hepatocellular carcinoma undergoing curative resection:a prognostic nomogram study[J].J Cancer,2018,9(1):148-156.
[17] 刘静,黄新华,赵燕,等.乌司他丁对老年患者腹腔镜子宫全切手术后早期褪黑素水平和认知功能的影响[J].临床麻醉学杂志,2018,34(8):21-25.
[18] 吴淑玻.腹腔镜根治性子宫切除术治疗老年人早期宫颈癌的效果探讨[J].中华老年医学杂志,2019,38(8):902-905.
[19] 曹馨.腹腔镜子宫切除术对患者机体免疫功能的影响研究[J].陕西医学杂志,2019,48(3):345-347,351.
[20] BERLIT S,TUSCHY B,WUHRER A,et al.Sexual functioning after total versus subtotal laparoscopic hysterectomy[J].Arch Gynecol Obstet,2018,298(2):337-344.
[21] 晓红,刘光莲,王燕妮.腹腔镜辅助下阴式全子宫切除术与腹式全子宫切除治疗子宫良性病变的效果及对盆底功能的影响比较[J].贵州医药,2019,43(12):1913-1915. |
|
服务与反馈：
|
|
【文章下载】【发表评论】【查看评论】【加入收藏】
|
| 提示：您还未登录，请登录！点此登录 |
|
|
|
|
copyright ©《东南大学学报(医学版)》编辑部
联系电话：025-83272481 83272483
电子邮件： bjb@pub.seu.edu.cn
苏ICP备09058364
|
|
