| Objective:This study was designed to explore the effect of laparoscopic subtotal hysterectomy on the tissue trauma in patients with myoma of uterus required to operation. Alterations in peripheral blood WBC count, neutrophil proportion, C reaction protein and tumor necrosis factor-αlevels in serum correlate with extent of tissue trauma. By assaying the above parameters and recording patients recovery situations during para-operative period, we evaluated differences in the tissue trauma and clinical outcome after laparoscopic and conventional surgical approaches (open surgery).Based on above findings, We try to provide further evidences for minimum incisions induced by the laparoscopic procedures.Methods:Data of sixty patients with myoma of uterus required to surgery were collected from April 2010 to December 2010 in the hospital of Tai Shan Medical College and the people's hospital of Tai Shan district. We devided the patients into two groups, 30 patients who chose Laparoscopic subtotal hysterectomy as study group, 30 patients who chose transabdominal subtotal hysterectomy as control group. Data of two groups were no statistical significance in terms of patient's age, weight ,height, and size of uterus between two groups (P>0.05). The patients with vital organs disorders, acute inflammation and stress response were not included. The WBC count ,neutrophil proportion rate,C reaction protein and tumor necrosis factor-αlevels were in peripheral blood at preoperative 1 day, postoperative 1 day and 3 day were measured and compaired. At the same time, the general conditions of patients were recorded, referring to lasting time of operation, volume of blood loss, recovered time of gastroenteric function as well as days of hospital stay.Results:60 cases were successful in patients. There weren't any complication occurred during and after procedures in both groups. There was no case of laparoscopic converted to open surgery.1 The WBC count and neutrophil proportion: Preoperative WBC count was normal without significant difference (P>0.05). At postoperative 1 day, WBC count significantly increased compared with preoperative level in both groups (P<0.05) ,but increasing degree was higher in open surgery group than that in laparoscopic surgery group significantly. Between two groups, WBC count was significant difference at postoperative 1 day (P<0.05). At postoperative 3 day, WBC count decreased in both groups, but still higher than preoperative level in both groups. It was higher in open surgery group than that in laparoscopic surgery group significantly (P<0.05). Preoperative neutrophil proportion was normal without significant difference (P>0.05). At postoperative 1 day ,neutrophil proportion significantly increased compared with preoperative level in two groups , Between two groups , Neutrophil proportion was not significant difference at postoperative 1 day (P>0.05). Neutrophil proportion decreased at postoperative 3 day in open surgery group, But it still highter than preoperative level (P<0.05). At postoperative 3 day, neutrophil proportion was still little higher than preoperative level in laparoscopic surgery group, but it had returned to preoperative level in laparoscopic group at this time.2 C reaction protein :No statistical significance between the two groups on C reaction protein level at preoperative 1 day was found(P>0.05) .The level of C reaction protein significantly increased at postoperative 1 day compared with preoperative level 1 day(P<0.05), but increasing degree was higher in open surgery group than that in laparoscopic surgery group significantly. Between two groups, the level of C reaction protein was significant difference at postoperative 1 day (P<0.05). At postoperative 3 day, the level of C reaction protein decreased, but was still higher than preoperative level in both groups (P<0.05). It was higher in open surgery group than that in laparoscopic surgery group significantly (P<0.05).3 Tumor necrosis factor-α: No statistical significance between the two groups tumor necrosis factor-αlevel at preoperative 1 day was found(P>0.05) .At postoperative 1 day , tumor necrosis factor-αsignificantly increased compared with preoperative level in two groups(P<0.05) , Between two groups , tumor necrosis factor-αwas not significant difference at postoperative 1 day (P>0.05). At postoperative 3 day, the level of tumor necrosis factor-αcontinue increased, was still higher than preoperative level in both groups (P<0.05). It was higher in open surgery group than that in laparoscopic surgery group significantly (P<0.05).4 Compared with the open surgery group laparoscopic subtotal hysterectomy has a more favorable clinical outcome because of less operation bleeding,less tissue trauma. shorter postoperative exhausting time and hospital days.Conclusion:The WBC count,Neutrophil proportion , the levels of C reaction protein and tumor necrosis factor-αwere lower significantly after laparoscopic surgery than transabdominal subtotal hysterectomy group. The level C reaction protein was increased significantly at 1 day after operation in two groups, But the increasing degree was higher in open surgery group than that in laparoscopic surgery group significantly. The level C reaction protein was decreased at 3 day after operation in two groups, but it was lower significantly in Laparoscopic subtotal hysterectomy than that in open surgery group. The level tumor necrosis factor-αwas increased significantly at 1 day after operation in two groups (P<0.05) , Between two groups , tumor necrosis factor-αwas not significant difference at postoperative 1 day (P>0.05). At postoperative 3 day, the level of tumor necrosis factor-αcontinue increased. It was higher in open surgery group than that in laparoscopic surgery group significantly (P<0.05). Laparoscopic surgery has a more favorable clinical outcome because of less tissue trauma. Laparoscopic techniques are feasible for curing myoma of uterus, because of potential benefit. |
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