宫腔镜手术对子宫黏膜下肌瘤患者卵巢功能、免疫功能及炎症因子水平的影响

目的:探讨宫腔镜手术对子宫黏膜下肌瘤患者卵巢功能、免疫功能及炎症因子水平的影响。方法:选取2017年1月～2018年4月期间我院收治的子宫黏膜下肌瘤患者107例为研究对象。根据不同的手术治疗方式将患者分为腹腔镜组(n=55,行腹腔镜子宫肌瘤切除术)和宫腔镜组(n=52,行宫腔镜子宫肌瘤切除术),比较两组患者围术期指标;比较两组术前、术后3个月卵巢功能促卵泡生长素(FSH)、雌二醇(E2)、黄体生成素(LH)、窦卵泡数量(AFC)]、细胞免疫指标(CD3+、CD4+、CD8+)、体液免疫指标(Ig G、Ig A、Ig M)水平;比较两组术前、术后7 d炎症因子白介素-2(IL-2)、白介素-6(IL-6)、C反应蛋白(CRP)]指标水平;记录两组术后并发症发生情况。结果:两组患者手术时间、术中出血量比较差异无统计学意义(P0.05);宫腔镜组术后下床时间、肛门排气时间、住院时间以及抗生素使用时间均短于腹腔镜组(P0.05)。两组患者术后3个月E2、LH、AFC比较差异无统计学意义(P0.05);腹腔镜组术后3个月FSH水平高于术前及宫腔镜组(P0.05)。腹腔镜组患者术后3个月细胞免疫指标低于术前及宫腔镜组(P0.05),但体液免疫指标与术前比较差异无统计学意义(P0.05);宫腔镜组术后3个月各项免疫指标与术前比较差异无统计学意义(P0.05)。两组患者术后7d IL-2、IL-6以及CRP水平均升高,但宫腔镜组低于腹腔镜组(P0.05)。腹腔镜组术后并发症发生率为10.91%(6/55),与宫腔镜组的9.62%(5/52)比较差异无统计学意义(P0.05)。结论:宫腔镜子宫肌瘤切除术对子宫黏膜下肌瘤患者卵巢功能、免疫功能影响较轻,同时可降低炎性因子水平,未出现严重并发症,具有一定的临床应用价值。

Effect of Hysteroscopic Surgery on Ovarian Function, Immune Function and Levels of Inflammatory Factors in Patients with Submucous Myoma of Uterus

ABSTRACT Objective: To investigate the effect of hysteroscopic surgery on ovarian function, immune function and inflammatory factors in patients with submucous myoma of uterus. Methods: 107 patients with submucous myoma were selected from January 2017 to April 2018. The patients were divided into laparoscopic group (n=55, laparoscopic surgery) and hysteroscopic group (n=52, hysteroscopic surgery). The perioperative indexes of the two groups were compared. The ovarian function follicle growth hormone (FSH), estradiol (E2), luteinizing hormone (LH) and the number of sinus follicles (AFC)], cellular immune index (CD3⁺, CD4⁺, CD8⁺), humoral immune index (IgG, IgA, IgM) were compared before and 3 months after operation ], and inflammatory factors interleukin-2 (IL-2), interleukin-6 (IL-6), C-reactive protein (CRP)] before and 7 days after operation were compared between the two groups.The postoperative complications were recorded in the two groups. Results: There was no significant difference in operative time and intraoperative bleeding volume between the two groups (P>0.05), the time of getting out of bed,anal exhaust,hospitalization and antibiotic use in hysteroscopy group were shorter than those in laparoscopy group (P<0.05). There was no significant difference in E2, LH and AFC between the two groups at 3 months after operation (P>0.05); FSH in the laparoscopic group increased significantly at 3 months after operation, but that in the hysteroscopy group was lower than that in the laparoscopic group (P<0.05). The cellular immunity index of laparoscopic group was lower than that of preoperative group and hysteroscopy group at 3 months after operation (P<0.05), but there was no significant difference in humoral immunity index between preoperative group and laparoscopic group (P>0.05). The levels of IL-2, IL-6 and CRP were elevated 7 days after operation in both groups, but those in hysteroscopy group were lower than those in laparoscopy group (P<0.05). The incidence of postoperative complications in laparoscopic group was 10.91% (6/55), which was not significantly different from 9.62% (5/52) in hysteroscopy group (P>0.05). Conclusion: Compared with laparoscopic hysteromyomectomy, hysteroscopic hysteromyomectomy for submucous myoma has a faster recovery, less influence on ovarian function and immune function, and can reduce the level of inflammatory factors, which has a certain clinical value.