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目的评价妇科腹腔镜手术对患者凝血、免疫功能和缺血再灌注的影响。方法2004年3月至2005年12月选择内蒙古医学院附属医院妇科收治的卵巢囊肿行腹腔镜手术和开腹手术患者各30例。记录术前、手术结束即气腹解除后10min、术后2h及24h血浆D-二聚体、P-选择素、血管性血友病因子(VWF)、CD69、CD30、脂质过氧化物(MDA)水平。结果腹腔镜组手术结束时及术后24h,P-选择素为(24.38±0.75)mg/L、(30.18±1.11)mg/L,D-二聚体为(0.68±0.05)μg/L、(0.80±0.05)μg/L,VWF为(153.00±7.82)mg/L、(180.70±3.98)mg/L,均显著高于同时期开腹手术组,差异有极显著性意义(P<0.01);术后2h、24hCD69开腹手术组[(11.10±1.81)%、(7.16±1.43)%]较腹腔镜组[(7.19±1.71)%、(3.87±0.79)%]升高更加明显(P<0.01),开腹手术组术后2h、24hCD30较术前均有明显升高(P<0.05),但腹腔镜组无明显变化(P>0.05);腹腔镜手术结束时患者血清MDA含量升高为(8.30±1.55)mg/L,与术前、术后24h比较差异有极显著性意义(P<0.01)。结论腹腔镜术后患者血液呈高凝状态;对患者器官产生缺血再灌注影响,但引起机体免疫功能变化较小。
Objective To evaluate the effect of gynecological laparoscopic surgery on coagulation, immune function and ischemia-reperfusion in patients. Methods From March 2004 to December 2005, 30 cases of ovarian cysts underwent laparoscopic surgery and laparotomy in gynecological department of Affiliated Hospital of Inner Mongolia Medical College were selected. The levels of plasma D-dimer, P-selectin, VWF, CD69, CD30, lipid peroxides MDA) level. Results The levels of P-selectin were (24.38 ± 0.75) mg / L, (30.18 ± 1.11) mg / L and D-dimer were 0.68 ± 0.05 μg / L at the end of operation and 24h after operation, (0.80 ± 0.05) μg / L and VWF were (153.00 ± 7.82) mg / L and (180.70 ± 3.98) mg / L respectively, all of which were significantly higher than that of open surgery group at the same period ) Was significantly higher than that of the laparoscopic group [(7.19 ± 1.71)%, (3.87 ± 0.79)%] in the laparoscopic open surgery group at 2h and 24h after operation (11.10 ± 1.81% vs 7.16 ± 1.43% (P0.05), but the laparoscopic group had no significant change (P0.05); at the end of laparoscopic surgery, serum MDA content (8.30 ± 1.55) mg / L, which was significantly different from preoperative and postoperative 24h (P <0.01). Conclusions After laparoscopic surgery, the blood of patients showed hypercoagulable state, and had the effect of ischemia-reperfusion on the organs of the patients, but caused little change of immune function.