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目的:探讨子宫肌瘤腹腔镜与开腹切除术围术期血清TNF-α、IL-6及IL-10的变化。方法:选择60例子宫肌瘤切除术患者随机平均分为两组,Ⅰ组行开腹子宫肌瘤切除术,Ⅱ组行腹腔镜下子宫肌瘤切除术;两种术式的手术时间均在100～120 min之内。于手术前1天、手术开始后90 min、术后第1天、术后第3天和第7天采集静脉血检测TNF-α、IL-6,IL-10水平。结果:①手术前1天:Ⅰ组和Ⅱ组TNF-α均明显高于正常值,而IL-6和IL-10均正常。②手术开始后90 min,Ⅰ组和Ⅱ组TNF-α、IL-6及IL-10均明显增高,与手术前1天、术后第1天、术后第3天和第7天比较有明显统计学差异。③术后第1天,Ⅰ组和Ⅱ组TNF-α、IL-6及IL-10仍维持较高水平,与手术前1天、术后第3天和第7天比较有明显统计学差异。④术后第3天,Ⅰ组TNF-α、IL-6及IL-10明显恢复,但仍高于正常,与术后第7天比较均有明显统计学差异,而Ⅱ组TNF-α、IL-6及IL-10明显降低并恢复正常,与术后第7天比较无统计学差异。⑤术后第7天,Ⅰ组和Ⅱ组TNF-α、IL-6及IL-10均恢复正常。结论:①手术创伤可引起炎性因子释放增加,抗炎性细胞因子分泌也随之增加。②子宫肌瘤腹腔镜切除术与开腹切除术围术期TNF-α、IL-6、IL-10均于手术结束前达高峰,但前者峰值较低,恢复更快,手术创伤更小。
Objective: To investigate the changes of serum TNF-α, IL-6 and IL-10 in patients undergoing laparoscopic and open excision of uterine fibroids. Methods: Sixty cases of myomectomy were randomly divided into two groups. Group I underwent open myomectomy and group II underwent laparoscopic myomectomy. The operation time was Within 100 ~ 120 min. The levels of TNF-α, IL-6 and IL-10 were measured at 1 day before surgery, 90 min after the start of surgery, 1 day after surgery, and 3 days and 7 days after operation. Results: ① One day before operation, TNF-α in group Ⅰ and group Ⅱ were significantly higher than normal, while both IL-6 and IL-10 were normal. ② At 90 min after the start of surgery, the levels of TNF-α, IL-6 and IL-10 in group Ⅰ and group Ⅱ were significantly higher than those in group Ⅰ and group Ⅱ Significant statistical difference. ③ On the first postoperative day, the levels of TNF-α, IL-6 and IL-10 in group Ⅰ and group Ⅱ remained at a high level, which were significantly different from those of the first day, the third day and the seventh day after operation . ④ On the third day after operation, TNF-α, IL-6 and IL-10 in group Ⅰ recovered obviously, but were still higher than those in normal group. There was a significant difference between the two groups IL-6 and IL-10 were significantly decreased and returned to normal, with no significant difference compared with the 7th day after operation. ⑤ After 7 days, the levels of TNF-α, IL-6 and IL-10 in group Ⅰ and group Ⅱ returned to normal. Conclusion: ① surgical trauma can cause increased release of inflammatory cytokines, anti-inflammatory cytokine secretion also increased. (2) The results of laparoscopic and open excision of uterine fibroids showed that the levels of TNF-α, IL-6 and IL-10 peaked at the end of the operation, but the former had a lower peak value, faster recovery and less trauma.