Primary Study Of Effect Of Laparoscopic Subtotal Hysterectomy On The Stress And Metabolic Responses For Patients

By the improvement of laparoscope equipment and clinical levels, laparoscopic surgery has been the major treatment of hysteromyoma. laparoscopic surgery has many prominent advantages compared with traditional surgical methods,such as smaller trauma,milder pain,less abdominal interference,less complication,more rapid rehabilitation and shorter length of hospital stay.Any operation has metabolic and stress responses.Is the effect on metabolic and stress responses of laparoscopic surgery less than traditionalsurgical method?Objective:To evaluate different operative approach's effect on stress and metabolism of LSH and TASH patients by measuring the change of Cor,FT3,FT4,TSH,ALT,AST at different sampling time point during pre-operation and post-operation.Methods: With clinical diagnosis and permitting criterion,hysteromy- oma patients were assigned to transabdominal superacervical hysterectomy (group A) and laparoscopic subtotal hysterectomy (group B).There was no statistic difference between two groups on age,size of uterus,number of hysteromyoma and preoperative haemachrome et al.The women had not major diseases,endocrine disorders and pregnancies. Perioperative condition of patients were recorded:operation time,blood loss volume,hospital days,postoperative recovery,et al.Blood samples were taken at preoperative 24 hours,postoperative 24 hours,postoperative 72 hours for biochemical tests of Cor,FT3,FT4,TSH,ALT,AST.We Compared the metabolic and stress response in two approachs.Results:1.Cor: No statistical significance between the two groups on Cor level at preoperative 24h (p=0.587)was found.At postoperative 24h,Cor level of the two groups was higher than pre-operation's.But the level of cortisol increased significantly in open surgery group (p=0.016);the level of cortisol in laparoscopic surgery group increased no significantly (p=0.057).Between two groups,the level of cortisol was significant differences at preoperative 24h (p=0.038).At postoperative 72h,the level of cortisol recovered in both groups(pA=0.512,pB=0.421);Between the two groups,the level of cortisol was no significant differences(p=0.493).2. FT3,FT4,TSH: No statistical significance between the two groups on FT3,FT4 and TSH level pre-operation(p=0.623,p=0.641, p=0.843)was found.2.1 FT3:FT3 level of 24h post-operation of the two groups was lower than pre-operation's significantly(pA=0.037,pB=0.039),and the amplitude was approximate(p=0.256).At postoperative 72h,the FT3 level could reach the level of preoperative state in laparoscopic surgery group (p=0.895),But the FT3 level in open surgery group didn't recover at preoperative state (p=0.044).Between two groups,the FT3 levels of 72h post-operation was significant differences (p=0.042).2.2 FT4:At postoperative 24h,FT4 dreased dramatically in open surgery group (p=0.041);FT4 dreased no significantly in laparoscopic surgery group(p=0.057).There was statistic difference between the two groups(p=0.040).At postoperative 72h,FT4 recovered to preoperative state in both groups(pA=0. 412,pB=0.578);Between two groups,the level of FT4 was no significant difference (p=0.723).2.3 TSH:At postoperative 24h,TSH dreased no significantly in both groups (p>0.05);At postoperative 72h,TSH increased gently in both groups(p>0.05).There was no statistic difference between the two groups (p>0.05).3. ALT,AST:The change of ALT and AST was gently during preioperation in both groups(p>0.05).There was no statistic difference among three sampling time points in both groups(p>0.05).4. Situation in operation:There was no dramatical differences between two groups on operation time(p=0.283),But significant differences of blood loss during surgery can be observed between two groups(p=0.039). The advantage of laparoscopic surgery on this way was obvious. 5.Postoperative recovery:postoperative gastroenteritic function recover in laparoscopically subtotal hysterectomy was earlier than in open surgery(p=0.036);hospital days in laparoscopic surgery were shorter than in open surgery(p=0.045).Conclusions:1 Compared with laparotomy, the laparoscope imposes less impact on stress and metabolic system.2 Patients of laparoscopic surgery suffer less surgical invasion and recover more quickly.