The Comparative Study On Stress Response Of Vaginal Hysterectomy, Laparoscopic Assisted Vaginal Hysterectomy And Vaginal Hysterectomy

Objective To compare the stress response and clinic convalescence of abdominal hysterectomy(AH),laparoscopic assisted vaginal hysterectomy(LAVH)and vaginal hysterectomy(VH).Method The data of clinic information and stress response markers(neutrophil cell, blood glucose,serum cortisol,interleukin—6(IL-6),C reactive protein(CRP))of the three procedures were collected prospectively in 2003 and 2005.Every group include 15 cases.The data were analyzed in different year respectively.Result In both year 2003 and 2005,the average time of bowel exhaust,hospital stay,total recovery time evaluated by patients themselves and the postoperative pain scores were significantly less in LAVH and VH group than AH group(year 2003 P＜0.01,P＜0.01,P＜0.05,P＜0.05,respectively;year 2005 P＜0.01,P＜0.01,P＜0.05, P＜0.05,respectively).In both year 2003 and 2005,there were no difference in the changes of neutrophil cells,blood glucose and serum cortisol of LAVH,VH and AH group.In the year 2003 there were no significant difference in the change of IL—6 in the three group.In the year 2005,the change of IL—6 were significantly lower in the LAVH and VH group than AH in the time of operation,postoperative 2 hours, 12hours,next morning(P＜0.01,P＜0.01;P＜0.05,P＜0.01;P＜0.05,P＜0.01;P＜0.01, P＜0.05 respectively)and there was still significantly lower in VH group than in AH group in the second postoperative morning(P＜0.01).In the year 2003there were no significant difference in the change of CRP in the three group.In the year 2005,the change of CRP were significantly lower in the LAVH and VH group than AH in the time of postoperative 12 hours and next morning(P＜0.05,P＜0.01;P＜0.05,P＜0.01; respectively)and there was still significantly lower in VH group than AH group in the second postoperative morning(P＜0.05).There were no significant difference of IL-6 and CRP change between LAVH and VH group.Conclusion The patients underwent LAVH or VH had better convalescence than who underwent AH.After the doctors got experience,the operative stress responses were less in LAVH and VH group than AH group.