腹式及阴式子宫切除对机体免疫功能的影响

目的:研究经腹全子宫切除及经阴道全子宫切除对机体免疫功能的影响。方法:选择在我院接受手术治疗的子宫肌瘤及子宫腺肌病患者60例,其中30例施行经腹全子宫切除,30例施行经阴道全子宫切除,每个病例分别测定术前及术后24、72 h血清免疫球蛋白IgG、IgA、IgM及补体C3、C4含量;比较两组手术时间、术中出血量、术后病率、住院天数。结果:术前两组病例免疫球蛋白及补体含量比较差异无统计学意义(P>0.05);而手术后24 h两组病例免疫球蛋白及补体含量均下降,与术前比较P<0.05,其中经腹全子宫切除组较经阴道全子宫切除组下降明显,两组间比较P<0.05;手术后72 h阴式子宫切除组IgG、IgA、IgM及补体C3、C4含量回升与术前比较差异无统计学意义(P>0.05),而腹式子宫切除组除IgM及C4回升外,IgG、IgA及C3仍处于低水平;与经腹子宫切除组比较,阴式子宫切除组手术时间短,术中出血少,术后病率低,住院时间短。结论:经阴道全子宫切除对机体的创伤小,机体的应激反应轻,对机体的免疫功能影响小且持续时间短,有利于患者术后的康复。

Effects of abdominal hysterectomy and vaginal hysterectomy on immune function in patients

Aim: To study the influence of total hysterectomy via abdomen and via vagina on human immune function.Methods: Sixty cases of hysteromyoma and adenomyosis were chosen,in which 30 cases received hysterectomy via abdomen(abdominohysterectomy group),and 30 cases received hysterectomy via vagina(vaginal hysterectomy group).The values of IgG,IgA,IgM and complement C_3,C_4 of each patient were measured before the operation,the 24 hours and 72 hours after operation respectively.The mean time length of the operations,the bleeding volume in the operations,the rate of recurrence and the mean hospital stay of the two groups were compared.Results: The values of immunoglobulin and complements in both groups had no significant difference(P>0.05) before the operations.There were significant differences at the levels between pre-operation and post-operation(P<0.05).The values decreased at the 24 hours after the operations of both groups.The levels in the abdominohysterectomy group decreased more significantly than that in the vaginal hysterectomy group.(P<0.05).In the vaginal group,the levels at the 72 hours of post-operation,which were mentioned above,return to the levels of pre-operation,there were no significant differences(P>0.05).However,in the abdominohysterectomy group,the IgM and C_4 levels increased,while the levels of IgG,IgA and C_3 still remained low levels at the 72 hours post-operation.The vaginal hysterectomy group had shorter operative time length,less bleeding in the operations,less recurrent rate after the operations and shorter hospital stay than the abdominohysterectomy group.Conclusion: In the vaginal hysterectomy group,there are less trauma to the body,inducing lighter stress reactions than in the abdominohysterectomy group.It has little influence on the immunity and thus helps the patient recover better and faster in the vaginal hysterectomy group.