腹腔镜手术对异位妊娠患者应激代谢的影响(1)
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【摘要】 目的 评估腹腔镜和开腹手术对异位妊娠患者机体应激及代谢的影响。方法 以非随机方式分为腹腔镜组、开腹手术组。分别检测术前24 h、术后24 h和术后72 h血清中皮质醇、甲状腺激素(FT3、FT4、TSH)及肝酶(ALT、AST)水平的变化。比较两组在手术前、后外周血中上述激素及因子变化。结果 ①手术作为创伤均可升高血皮质醇的水平,但开腹手术组术后24 h皮质醇变化较腹腔镜组更为显著,两组在术后72 h均能恢复至术前水平;②腹腔镜组手术前后甲状腺相关激素(FT3、FT4、TSH)反应较为轻微且恢复较为迅速,于术后72 h均能恢复术前的水平。开腹组则激素水平波动较大,于术后72 h FT3仍未能恢复术前水平;③腹腔镜组及开腹组对肝酶(ALT、AST)影响不明显;④两种术式的手术操作时间基本相似,但腹腔镜手术中患者的失血量明显少于开腹手术。结论 腹腔镜手术较开腹手术对机体的应激及代谢的影响小,腹腔镜手术是异位症患者有效安全损伤少的治疗方法。
【关键词】 腹腔镜手术;开腹手术;应激;代谢
The study of effect of laparoscopic surgery on stress and metabolism for ectopic pregnancy patients
DAI Xiao-yun,LE Ai-wen,WANG Zhong-hai,et al.Department of Obstetric and Gynecology, Shenzhen Sixth People’s Hospital,Guangdong Medical College,Shenzhen 518052,China
【Abstract】 Objective To evaluate laparoscopic surgery and open surgery approachs’effect on stress and metabolism of ectopic pregnancy patients.Methods With clinical diagnosis and permitting criterion,ectopic pregnancy patients were assigned to laparoscopic surgery and open surgery.Serum concentrations of cortisol、FT3、FT4、TSH 、ALT、AST were measured at preoperative 24 hours, postoperative 24 hours,postoperative 72 hours.We compared their change in two operative approachs.Results ①At postoperative 24 h,the level of cortisol increased more significantly in open surgery group than that in laparoscopic surgery group.The cortisol recovered at postoperative 72 h in both groups.But the degree of change in open surgery group was much greater than in laparoscopic surgery group.②the change of FT3、FT4 and TSH was gently and could reach the level of preoperative state at postoperative 72 h in laparoscopic surgery group.The change of FT3、FT4 and TSH was high,FT3 could not return at postoperative 72 h in open surgery group.③ALT and AST did not changed obviously in both groups.④There was no dramatically differences between two groups on operation time, but blood loss during surgery in laparoscopic group was lower than in open surgery.Conclusion The metabolic and stress response in laparoscopic surgery is lighter than in open surgery ......
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