Clinical Comparison Of Stress Response By Abdominal Hysterectomy And Vaginal Hysterectomy

Objective:Hysterectomy is a basic operation in gynecological surgery and minimally invasive techniques have been also introduced in gynecological medicine as it becomes more popular in the medical field. Vaginal Hysterectomy, as it follows the principle of minimally invasion, has regained its acceptance by gynecologists. This technique has been reported by many authors, most of which were on the operation time, blood loss in the operation, and morbidity after the operation, rate of complication, and hospital expenses.Hysterectomy usually results in a series of changes in hormone, metabolism and inflammation. Quantitative comparison of such stress response could provide an indication on the injury degrees of tissues. After the operation, the first and most stress response is mediated by the release of cortisol, catecholamine and cytokine in great quantity, resulting in immunological injuries.In this paper,150 patients were divided into two groups (as Abdominal Hysterectomy, AH and Vaginal Hysterectomy, VH) and were observed for early responses in neuroendocrinological and immunological indices, including the highest mean body temperature (i.e. the highest daily mean body temperature within 3 days after the operation), peristalsis recovery (the first time of passage of gas after the operation), the ratio between WBC and neutrophil granulocytes, C-response protein level and IL-6 level. Such an analysis of clinical response would be a theoretical preparation for hysterecotomical operation with minimal invasiveness, safety, feasibility and advantage.Clinical Observation:The patients with indications for hysterecotomy were from Changchun Gynecological Hospital between October,2007 and October,2009.75 of them received Abdominal Hysterectomy (AH) and Vaginal Hysterectomy (VH) and were studied prospectively. They were of a mean age at 45.7 (the oldest being 62 and youngest being 38). Among the patients, 85.3% had normal parturition,12% received Caesarean sections,2.7% without childbearing history. Among the 102 cases of hysteromyoma, there were 33 cases of adenomyosis and 15 cases of misfunctional endometrorrhagia. There 33 cases had uterus size smaller than that of 6 weeks pregnancy,87 cases had uterus sizes of 6～8 weeks pregnancy (including 8 weeks),21 cases where uterus of 8～10 weeks pregnancy (including 10 weeks) and 9 cases had uterus of 10～12 weeks pregnancy (including 12 weeks). There were 36 cases with a history of pelvic surgeries, laparotomy and 12 cases of appendectomy,6 cases of bilateral tubal ligation,18 cases of cesarean sections,6 cases of ovaries operations, and 6 cases of tubal ligation. There were 12 cases with a history of two pelvis laparoscopic operations and 9 cases of hysteromyoma complicated with adenomyosis. Malignant genital tract tumors were excluded in the 150 patients, who were regarded as patient's good general conditions and could endure the imminent surgical operation, and who had no insufficient functions or malfunctions in vital organs and systematic diseases, such as simple uterine diseases, lumps/swelling in Fallopian tubes or ovaries and observable adhesion. There were no statistically significant differences between the patients in the two groups in ages, medical history, delivery modes, diseases and history of operation.Methods:No observable abnormalities were found by routine gynecological check-ups, laboratory examinations, and general routine check-sups at the time of mental nursing before the operation. All the patients received successful VH or AH under CSEA by 3-4 experienced surgeons in accordance to surgical procedures. The axillaty temperature was recorded for highest body temperature at 6:00,10:00,14:00 and 18:00 for three days after operation. Peristalsis before operation and the time of peristalsis recovery, i.e. the first time of passage of gas after the operation after operations, were recorded. Blood routine tests were done for WBC, NGR before the operation and 24 h after the operation, as well as C-RP and IL-624 h and 48 h after operation. These indices were compared for characteristic changes.Results: Among the two groups of the 75 patients received VH or AH, highest mean body temperature with 3 days after the operation in VH was over 37.5℃, which was proved by x2 test to be significantly lower than that in AH (P＜0.05). The number of patients recovering their peristalsis after 48h in VH was proved by x2 test to be significantly lower than that in AH (P<0.05). Although WBC in the two groups increased, the number of patients with WBC over the normal values (>10.0×109/L) within 4h in VH proved by x2 test to be significantly lower than that in AH (P＜0.05). NGR increased in the two groups and the number of patients with NGR of BP over the normal values (>70%) within 24 h after the operation more than that 24 h before the operation in VH was proved by x2 test to be significantly lower than that in AH (P<0.05). Serum CRP mean level 48 h after operation was proved by t test to be significantly higher than that in 24 h after the operation in the two groups (P<0.05).Serum CRP level 48h after the operation in the two groups was proved by t test to be significantly higher than that in VH (P<0.05). IL-6 mean level 48 h after the operations was proved by t test to be significantly higher than that at 24h before operation in the two groups (P＜0.01). Serum IL-6 level 48 h after the operation in AH was proved by t test to be significantly higher than that in VH (P<0.01).Conclusion:Vaginal hysterectomy brought about less severe stress responses than abdominal hysterectomy with less impact on the immunological functions, indicating a faster recovery after the operation. Vaginal hysterectomy was proved as a chosen minimally invasive technique of better safety and feasibility in suitable cases. It enjoys advantage in clinical applications and should have a wider application.