| Objectives To investigate the influence of laparoscopic surgery and laparotomy in the treatment of benign ovarian tumor and benign uterus disease, and also the influence of different surgical methods and surgery time in the haemodynamics, inflammatory factor and peritoneum coagulation and fibrinolytic system.Methods 152 patients were selected with the benign ovarian tumor and benign uterus disease hospitalized in Hebei United University Affiliated Gynaecology and Obstetrics Hospital from April, 2013 to October, 2014, at the age from 26 to 73. Besides, they did not have any underlying diseases. According to their willing, they were divided into CO2 pneumoperitoneum group(P, n=81) and comtrol group(C, n=71). After pre-operative diagnostic curettage, they were excluded with the endometrial lesion. Moreover, they went through antibiotic quiescent point impact preventative anti-inflammatory 30 min before the surgery. Both of them adopted intravenous inhalational anesthesia. Afterwards, the patients from the L showed dorsal elevated position. As for some patients with hysteromyoma, get the lithotomy position via the vaginam. The patients from A showed conventional horizontal position. All laparoscopic surgeries adopt OLYMPUS UHI–3 insufflator. The pneumoperitoneum pressure was maintained between 12 mm Hg and 15 mm Hg. Within 24 hours before and after operation, the forearms of the patients should conduct the blood routine examination(BRT), hypersensitivity C-reaction protein(hs-CRP), and D-D in basilica vein. Before the surgery(A group finished establishment of pneumoperitoneum, and each Trocar took place; L group conducted after the abdominal surgery) and before the ending of the surgery(L group finished wash and investigation, before withdrawing from Trocar; the L group conducted before the abdominal closing), collect about 1ml radial artery blood from the patients, check the arterial blood gas index, observe PCO2, p H, HCO3, PO2, collect parietal peritoneum(above 5cm away from Trocar cutting or laparotomy incision), and place them in the stationary liquid. In the laboratory, with regard to the common paraffin embedding section, dye the tissue section through the immumohistochemistry SP method(DAB developing). Calculate the positive cell expression rate of the tissue plasminogen activator(t-PA) and urokinase plasminogen activator in the peritoneum of the patients from both groups.Results 1 As for the patients from the P and A groups, the difference on their age and BMI do not have statistical significance(P>0.05). 2 The post-operative blood routine of both groups has more obvious change that their pre-operative blood routine, but their difference does not have statistical significance. The post-operative hypersensitivity Creactive protein of both groups has significant difference(P<0.05). 3 D-D change of both groups: Through the comparison between both groups, the post-operative D-D was higher than he pre-operative D-D, and the difference has statistical significance(P<0.05). However, the difference from the comparison between two groups after the operation does not have significant difference(P>0.05). 4 The post-operative t-PA positive rate does not have significant difference. The positive rate of u-PA A group is higher than that of the L group(P<0.05). 5 PCO2, p H, and HCO3-have significant change before and after pneumoperitoneum(P<0.01). Besides, the change of PCO2 has high correlation with the ventilation duration. The p H of the post-operative P group is significantly lower than that of the A group(P<0.05). The PO2 of intra-group and between-group does not have significant change.Conclusions 1 The positive rate of u-PA A group is higher than that of the L group. 2 The laparoscopic surgery and traditional laparotomy surgery have the similar influence on D-dimer. 3 After laparoscopic surgery, hs-CRP is lower than that of laparotomy group;the latter causes the LYM decreased degree is bigger than the former. 4 The MAP and HR will be increased in both group,that in laparotomy group would be higher. 5 Both ways have impact on the arterial blood gases of the patients, but the obvious increasing of PCO2 will be caused after the laparoscopic surgery. The change of the intra-group PCO2 is related to the time. |
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