Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy

被引:63
作者
Yuen, PM [1 ]
Mak, TWL
Yim, SF
Kee, WDN
Lam, CWK
Rogers, MS
Chang, AMZ
机构
[1] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Obstet & Gynaecol, Shatin, NT, Hong Kong
[2] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Chem Pathol, Shatin, NT, Hong Kong
[3] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Anesthesia & Intens Care, Shatin, NT, Hong Kong
关键词
Hysterectomy; laparoscopy; laparotomy; metabolic; inflammatory;
D O I
10.1016/S0002-9378(98)70243-1
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: Our purpose was to quantify and compare the metabolic and inflammatory changes after laparoscopic and abdominal hysterectomy. STUDY DESIGN: Forty-four patients with no major medical disease requiring abdominal hysterectomy for benign disorders were randomly assigned to have laparoscopic hysterectomy (n = 20) and abdominal hysterectomy (n = 24). Venous blood and 24-hour urine samples were collected the day before and for each of the first 3 postoperative days. RESULTS: No differences were present in demographic characteristics, operating time, and uterine weight between the two groups. No major complications were encountered. The laparoscopic hysterectomy group had a significantly lower postoperative morphine consumption (median 5.5 vs 14 mg, P < .05), lower febrile morbidity rate (15% vs 45.8%, P < .05), and shorter hospital stay (median 4 vs 6 days, P < .001) and demonstrated a less intense stress response in terms of serum interleukin-8 (median 50.6 vs 73.9 pg/mL x hour x 10, P = .01), C-reactive protein (median 28.1 vs 44.7 mg/L x hour x 10(2), P = .005), cortisol (median 23.4 vs 27.2 mg/mL x hour x 10(3), P = .04), white blood cell count (median 59.5 vs 69.8 10(9)/L x hour x 10, P = .009), 24-hour urinary excretion of cortisol (median 34.8 vs 44.2 nmol/L x hour x 10(3), P = .02), and norepinephrine (median 80.8 vs 132.4 nmol/L x hour x 10(2), P = .001). No significant difference was detected in plasma glucose (median 41.5 vs 45.6 mmol/L x hour x 10, P = 6) and 24-hour urinary excretion of epinephrine (median 32.2 vs 34.1 nmol/L x hour x 102, P = .3). CONCLUSION: Laparoscopic hysterectomy is associated with a lower morbidity and a less intense stress response than abdominal hysterectomy for benign diseases.
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页码:1 / 5
页数:5
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