高强度聚焦超声对子宫肌瘤患者围手术期应激及免疫功能的影响

发布时间：2018-03-17 22:04

本文选题：高强度聚焦超声　切入点：子宫肌瘤　出处：《川北医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨高强度聚焦超声(HIFU)对子宫肌瘤患者围手术期应激及免疫功能的影响。方法:选取2016年6月至2016年12月在川北医学院附属医院妇产科就诊并经临床及影像学检查确诊的子宫肌瘤患者87例为研究对象,根据患者的治疗意愿分别将患者分为高强度聚焦超声(HIFU)治疗组(观察组)、腹腔镜下子宫肌瘤剔除术组(对照组)和经腹子宫肌瘤剔除术组(对照组),其中HIFU组38例,腹腔镜组29例,经腹组20例。分别于术前24h内及术后24h抽取患者肘静脉血,采用流式细胞术检测外周血CD4+、CD8+T淋巴细胞比例,并计算CD4+/CD8+比值;酶联免疫吸附法(ELISA)检测血浆IL-2、IL-10浓度;血细胞分析仪检测白细胞计数及中性粒细胞百分比。比较三组间及组内各检测指标术前及术后24h的变化。结果:(1)三组患者之间术后24h外周血CD4+T淋巴细胞比例及CD4+/CD8+比值相比较,差异有统计学意义(P0.05),其中,腔镜组及经腹组术后CD4+T淋巴细胞比例及CD4+/CD8+比值明显低于HIFU组,结果有明显差异(P0.05);腔镜组和经腹组术后CD4+T细胞比例及CD4+/CD8+比值比较,差异无统计学意义(P0.05)。三组患者之间术后24h CD8+T细胞比例的比较,结果未见明显差异(P0.05)。各组内比较,腹腔镜组和开腹组术后CD4+、CD8+T淋巴细胞比例及CD4+/CD8+比值均较术前降低,差异具有统计学意义(P0.05);HIFU组术后CD4+、CD8+T细胞比例及CD4+/CD8+比值较术前无明显变化,结果无明显差异(P0.05)。(2)三组患者间术后24h血浆IL-2、IL-10水平比较,差异有统计学意义(P0.05),其中,HIFU组术后24h血浆IL-2水平明显高于腔镜组及经腹组,差异有统计学意义(P0.05),腔镜组和经腹组比较,结果无明显差异(P0.05);经腹组术后24h血浆IL-10水平明显高于HIFU组及腔镜组,差异具有统计学意义(P0.05),腔镜组和HIFU组比较,结果无差异(P0.05)。各组内比较,HIFU组术后24h血浆IL-2水平较术前升高(P0.05),腔镜组和开腹组术后IL-2水平较术前降低,结果有明显差异(P0.05);开腹组术后24h血浆IL-10浓度较术前升高,差异有统计学意义(P0.05),HIFU组和腔镜组术后IL-10浓度较术前无明显变化(P0.05)。(3)三组患者间术后白细胞计数及中性粒细胞百分比各不相同,经腹组最高,腔镜组次之,HIFU组最低,差异具有统计学意义(P0.05)。各组内比较,三组患者术后白细胞计数及中性百分比较术前均不同程度升高,其中经腹组升高最明显,腔镜组次之,HIFU组升高幅度最小,差异有统计学意义(P0.05)。结论:(1)高强度聚焦超声(HIFU)治疗子宫肌瘤在围手术期引起患者机体的应激反应较开腹组和腔镜组轻,创伤小。(2)HIFU治疗子宫肌瘤可能在一定程度上增强机体围手术期的细胞免疫功能,是一种更为安全、微创的治疗方式。
[Abstract]:Objective: to investigate the effect of high intensity focused ultrasound (HIFU) on perioperative stress and immune function in patients with uterine leiomyoma. Eighty-seven patients with hysteromyoma confirmed by imaging examination were the subjects of the study. According to the intention of treatment, the patients were divided into three groups: high intensity focused ultrasound (HIFU) group (observation group), laparoscopic hysteromyomectomy group (control group) and abdominal myomectomy group (control group, 38 cases in HIFU group). There were 29 cases in the laparoscopic group and 20 cases in the transabdominal group. The blood samples of cubital vein were extracted within 24 hours before operation and 24 hours after operation. The ratio of CD4 / CD8 T lymphocytes in peripheral blood was measured by flow cytometry, and the ratio of CD4 / CD8 was calculated. The concentration of IL-10 in plasma was detected by enzyme linked immunosorbent assay (Elisa). The white blood cell count and neutrophil percentage were measured by hematology analyzer. The changes of CD4 T lymphocytes in peripheral blood were compared between the three groups and within the three groups 24 hours before and 24 hours after operation. Compared with the ratio of CD4 / CD8, The percentage of CD4 T lymphocytes and the ratio of CD4 / CD8 in the endoscopic group and the transabdominal group were significantly lower than those in the HIFU group (P 0.05), and the ratio of CD4 T cells and CD4 / CD8 in the endoscopic group and the transabdominal group were significantly lower than those in the HIFU group. There was no significant difference in the ratio of CD8 T cells between the three groups at 24 hours after operation. There was no significant difference in the ratio of CD4 T lymphocytes and CD4 / CD8 between the laparoscopic group and the laparotomy group. The ratio of CD4 / CD8 and the ratio of CD4 / CD8 in the laparoscopic group and the open group were lower than those in the preoperative group. There was no significant difference in the ratio of CD4 / CD8 T cells and the ratio of CD4 / CD8 between the three groups after operation. The results showed that there was no significant difference between the three groups in the levels of IL-2 and IL-10 in plasma 24 hours after operation. The plasma IL-2 level in HIFU group was significantly higher than that in endoscopic group and transabdominal group at 24 hours after operation, and the difference was statistically significant (P 0.05). Results there was no significant difference between the two groups (P 0.05), the plasma IL-10 level in the transabdominal group was significantly higher than that in the HIFU group and the endoscopic group at 24 h after operation, and the difference was statistically significant (P 0.05). The difference between the endoscopic group and the HIFU group was significant. Results there was no significant difference between the two groups (P 0.05). The plasma IL-2 level was higher than that in the preoperative group 24 hours after operation, and the IL-2 level in the laparoscopy group and the laparotomy group was lower than that in the preoperative group, the results showed that there was a significant difference between the two groups, and the plasma IL-10 level in the open group was higher than that in the preoperative group at 24 hours after operation, and that in the laparotomy group was higher than that in the preoperative group. The difference was statistically significant (P 0.05) and the postoperative IL-10 concentration in the endoscopic group and the endoscopic group were not significantly different from those before the operation (P 0.05). The leukocyte count and neutrophil percentage were different among the three groups, the highest in the transabdominal group and the lowest in the second group in the endoscopic group. The difference was statistically significant (P 0.05). The white blood cell count and neutrophil percentage in the three groups were increased in different degrees before operation, especially in the transabdominal group, followed by the HIFU group. Conclusion: high intensity focused ultrasound (HIFU) in the treatment of uterine leiomyoma in perioperative period caused a lighter stress response than that in the laparotomy group and the endoscopic group. The treatment of uterine leiomyoma with HIFU may enhance the cellular immune function in perioperative period and is a more safe and minimally invasive treatment method.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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