腹腔镜下手术与开腹手术治疗子宫肌瘤术后炎性应激反应的对比研究

目的：研究腹腔镜下手术与开腹手术治疗子宫肌瘤术后的炎性应激反应。方法：选取130例子宫肌瘤患者资料，并随机分为观察组（给予腹腔镜下手术）和对照组（给予开腹手术），每组65例。检测术后炎性因子水平，观察手术创伤指标，并分析两者的相关性。结果：①治疗后，两组患者炎性因子水平均高于治疗前，且观察组患者的白细胞介素-1（IL-1）水平和肿瘤坏死因子α（TNF-α）均低于对照组，差异有统计学意义（r=5．892，t=11．842，p〈0．05）②两组患者手术时间相比，差异无统计学意义（t=0．932，P〉0．05）,③观察组患者的术中出血量、术后肛门排气时间、卧床时间以及NRS疼痛评分均低于对照组，差异有统计学意义（f=7．842，t=7．283，t=8．213，t=7．883,P〈0．05）,④术中出血量、术后肛门排气时间、卧床时间以及NRS评分均与IL-I呈正相关，，0分别为0．485、0．521、0．442、0．451,与TNF-α呈正相关，r2产分别为0．556、0．513，0．423及0．458，差异有统计学意义。结论：腹腔镜下手术有助于减小手术创伤、缓解术后炎性应激反应，且炎性应激程度与手术创伤程度有密切的相关性。

Comparative study on inflammation stress reaction between laparoscopic operation and open operation in treating hysteromyoma

Objective： To study the inflammation stress reaction between laparoscopic operationand open operation in treating hysteromyoma. Methods： hysteromyoma patients in our hospital from January 2011 to December 2012 were enrolled and randomly divided into observation group given laparoscopic operation and control group given open operation. Then inflammatory factors levels were detected, operation trauma index were observed and the correlation were analyzed. Results： （1）After treatment, inflammatory factor levels of two groups were higher than those before treatment and IL-1（t=5.892, P〈0.05）, TNF-a （t=11.842, P〈0.05）levels of observation group were lower than control group, the difference was statistical significance（P〈0.05）; （2） There was no significant difference between two groups of operation time （t = 0.932, P〉 0.05）, intraoperative bleeding volume （t= 7.842, P 〈 0.05）, postoperative anal exhaust time（t=7.283, P〈0.05）, bed time（t=8.213, P〈0.05） and NRS pain scores（t=7.883, P〈0.05） of observation group were lower than control group（P〈0.05）; （3） Intraoperative bleeding volume, postoperative anal exhaust time, bed time and NRS pain scores were positively correlated with IL-1, P were separately 0.485, 0.521, 0.442, 0.451; and positively correlated with TNF-a levels, P were separately 0.556, 0.513, 0.423, 0.458, the difference was statistical significance（P〈0.05）. Conclusion： Laparoscopic operation is helpful to reduce the operation wound and relieve postoperative inflammatory reaction; and there was close correlation between inflammatory stress and operation trauma.