腹腔镜与开腹子宫肌瘤剜除术氧化应激状态的比较

目的 探讨腹腔镜手术对人体氧化应激的影响。方法 测定20例子宫肌瘤患者在接受腹腔镜手术前、手术结束时(气腹解除后5min)及术后24h血浆丙二醛(MDA)、谷胱甘肽过氧化物酶(GPx)和血浆总抗氧化能力(AOA)的水平,并与20例开腹手术患者术前、手术结束时(缝合腹壁时)及术后24h的水平进行比较。结果 手术结束时2组血浆MDA水平均增加(腹腔镜组P<0.01,开腹组P=0.19);术后24h腹腔镜组恢复至术前水平(P=0.20),而开腹组与术前比较继续升高(P<0.01)。血浆GPx活性及AOA水平在手术结束时两组均降低(腹腔镜组P<0.01、P<0.01;开腹组P=0.23、P=0.43);术后24h与术前比较腹腔镜组GPx活性部分恢复(P=0.11),AOA维持在手术结束时的水平(P<0.01),而开腹组GPx活性和AOA水平继续下降(P<0.01,P<0.01)。两组相比腹腔镜组术后24hMDA水平低(P<0.01),GPx活性高(P<0.05),AOA水平无差异(P=0.33)。结论 腹腔镜手术过程中有氧化应激现象产生,但术后基本得以恢复,优于开腹组。

Comparative study of the impacts of laparoscopic and open laparotomic surgeries on oxidative stress in patients with uterine myomas

Objective To evaluate the impact of laparoscopic surgery on oxidative stress in patients with uterine myomas. Methods Plasma malondialdehyde (MDA), antioxidant activity (AOA), and glutathione peroxidase (GPx) activity in 20 patients with uterine myomas were measured before, at the end of (5 min after deflation), and 24 h after laparoscopic surgery, for comparison with the measurements in 20 patients receiving laparotomic surgery at the same time points. Results Immediately following laparoscopic surgery, plasma MDA level increased significantly as compared with the preoperative level (P<0.01) and recovered the normal level 24 h after the operation; but in laparotomic surgery, plasma MDA level underwent a slight increase in the immediately early postoperative stage and continued to increase 24 h after the operation. In laparoscopic surgery, GPx and AOA decreased significantly in the early postoperative stage (P<0.01) and recovered to some extent 24 h postoperatively, whereas in laparotomic surgery, GPx and AOA slightly decreased immediately following the operation and further decreased 24 h after the operation. Compared with patients receiving laparotomic surgery, laparoscopic patients had significantly lower plasma MDA level (P<0.01) and significantly higher GPx activity (P<0.01) with comparable AOA level (P=0.33) 24 h after the operation. Conclusion Free radical produces at the end of a laparoscopic procedure, possibly as a result of ischemia-reperfusion induced by the inflation and deflation of the pneumoperitoneum.