腹腔镜子宫次全切除术对患者机体应激的影响

为了评估腹腔镜次全子宫切除（LSH）和开腹次全子宫切除（TASH）对机体应激影响，选用以随机方式分为开腹次全子宫切除组（A组）、腹腔镜次全子宫切除组（B组）。取术前24h、术后24h和术后72h患者外周静脉血，分别检测血清中皮质醇（Cor）、甲状腺相关激素（FT3、FT4、TSH）水平的变化。开腹组内皮质醇水平于术后24h则高于术前（P=0．016），而腹腔镜组升高不显著（P=0．057），两者比较差异有统计学意义（P=0．038）。术后24h，两组病人FT3浓度下降，此时点两组间差异无统计学意义（P=0．256）。术后72h，两组间差异有统计学意义（P=0．042）。术后24h开腹手术组FT4浓度低于同时点腹腔镜手术组FT4浓度（P=0．040）。术后72h两组均能恢复至术前水平（pA=0．412，pB=0．578），两组间差异无统计学意义（P=0．723）。TSH的比较：开腹组与腹腔镜组比较术后24h均下降，术后72h又有所上升，但各时点变化均不显著（P〉0．05），且两组间差异也无统计学意义（P〉0．05）。腹腔镜次全子宫切除比开腹次全子宫切除对机体的应激影响小。

The effect of laparoscopic subtotal hysterectomy on the stress responses for patients

To evaluate different operative approach＇s effect on stress in LSH and TASH patients, hysteromyoma patients were assigned to transabdominal superacervical hysterectomy （group A） and laparoscopic subtotal hysterectomy （group B）. Blood samples were taken before operative 24 hours, and after operative 24 hours and 72 hours for biochemical tests of cortisol, FT3, FT4 and TSH. The stress response in two approaches was compared. Result showed that after operative 24h, cortisol level of the two groups was higher than that of pre-operation, the level of cortisol increased significantly in open surgery group （P = 0. 016 ）, but the level of cortisol in laparoseopic surgery group increased no significantly （ P = 0. 057 ）. Between two groups, the level of cortisol was significant differences before operative 24h （P = 0. 038 ）. FT3 levels of after operation 24h of the two groups were lower than pre-operation＇s significantly and the amplitude was approximate （P = 0. 256）. And the FT3 levels of 72h post-operation was significant differences （P = 0. 042）. At postoperative 24h, FT4 in open surgery group （ P = 0. 041 ） was lower than in laparoscopic （ P = 0. 040）. At postoperative 72h, FT4 recovered to preoperative state in both groups（ PA = 0. 412, PB = 0. 578 ） ; The level of RF4 was no significant difference between two groups （P = 0. 723）. At postoperative 24h, TSH decreased in both groups （P 〉 0. 05 ） ; At postoperative 72h, TSH increased in both groups which had no statistic difference in different time. There was statistic difference between the two group （ P 〉 0. 05 ）. Compared with laparotomy, the laparoscope imposes less impact on physical stress.