腹腔镜手术对异位妊娠患者甲状腺激素、肝酶影响的研究

目的:探讨腹腔镜手术对异位妊娠患者代谢的影响及与开腹相比的优势所在。方法:采用放免和生化的方法检测需要手术治疗的58例异位妊娠患者(腹腔镜组31例;开腹组27例)手术前后甲状腺相关激素及肝酶的变化,并对患者的术前、术后情况及两组结果的差别进行比较和分析。结果:腹腔镜组术后24h游离T3(FT3)水平显著下降,明显低于术前水平〔(6.6±1.0)pmol/Lvs(7.9±1.4)pmol/L,P<0.05〕,但于术后72h基本回升至术前水平。开腹组术后24hFT3、游离T4(FT4)水平均显著下降,明显低于术前〔(6.0±1.1)pmol/Lvs(8.5±1.6)pmol/L,P<0.05;(4.7±2.5)pmol/Lvs(17.3±5.0)pmol/L,P<0.05〕;且FT3在术后72h仍未恢复到术前水平〔(6.1±1.1)pmol/Lvs(8.5±1.6)pmol/L,P<0.05〕。两组比较,开腹组术后24hFT4水平下降率明显大于同时点腹腔镜组,两者相比有显著性差异〔(72.8±14.5)%vs(35.8±33.9)%,P<0.05〕;开腹组术后72hFT3水平未能恢复到术前水平,较腹腔镜组恢复慢。两手术组促甲状腺激素及肝酶变化均不显著。腹腔镜组术中出血量明显少于开腹组〔(24.7±19.6)mlvs(69.0±27.2)ml,P<0.05〕,术后排气时间明显早于开腹组〔(27.3±10.2)hvs(38.8±12.1)h,P<0.05〕。结论:腹腔镜手术和开腹手术都能在术后早期(24h)抑制异位妊娠患者甲状腺激素的分泌,但腹腔镜的影响幅度小,恢复快。手术对促甲状腺激素和肝酶无明显影响。腹腔镜手术治疗异位妊娠出血少,恢复快。

Effect of laparoscopic surgery on metabolism of thyroid hormones and liver enzymes in ectopic pregnancy.

Objective:To investigate the effect of laparoscopic surgery on metabolism of thyroid hormones and liver enzymes,the advantages of laparoscopic surgery were compared to laparotomy in ectopic pregnancy patients.Methods:Serum concentrations of FT3,FT4,TSH,ALT and AST in patients with ectopic pregnancy who received operative treatment were detected by radio-linked immunoassay(RIA) and biochemistry at preoperative 24 hours,postoperative 24 hours and postoperative 72 hours.At the same time,peri-operative conditions of the patients were observed and compared in laparoscopic surgery group(LS group) and laparotomy group(LA group).Results:In LS group,the serum value of FT3 at postoperative 24 hours was significantly lower than that preoperative(6.6±1.0 pmol/L vs 7.9±1.4 pmol/L,P<0.05),but it could return to preoperative baseline approximately at postoperative 72 hours.In LA group,both serum values of FT3 and FT4 were decreased significantly at postoperative 24 hours and much lower than those of preoperative levels(6.0±1.1 pmol/L vs 8.5±1.6 pmol/L,P<0.05),(4.7±2.5 pmol/L vs 17.3±5.0 pmol/L,P<0.05),moreover,the value of FT3 still could not return preoperative baseline at postoperative 72 hours(6.1±1.1 pmol/L vs 8.5±1.6 pmol/L,P<0.05).The decline degree of FT4 in LA group at postoperative 24 hours was significantly greater than that in LS group at the same time point(72.8%±14.5% vs 35.8%±33.9%,P<0.05).The blood loss during operation in LS group was significantly lower than that in LA group(24.7±19.6 ml vs 69.0±27.2 ml,P<0.05),and the time of postoperative gastroenteric function recovered in LS group was significantly shorter than that in LA group(27.3±10.2 hours vs 38.8±12.1 hours,P<0.05).Conclusion:Both laparoscopic surgery and laparotomy can restrain the secretion of thyroid hormones in patient with ectopic pregnancy,but influence degree of laparoscopic surgery is less and recovery of hormones is more quickly.Surgery itself has scarcely effect on TSH and hepatic enzymes(ALT,AST).Laparoscopic surgery is a way of less blood loss and quicker recovery for the ectopic pregnancy patients.