發(fā)布時間：2018-03-17 22:04

  本文選題：高強(qiáng)度聚焦超聲　切入點(diǎn)：子宮肌瘤　出處：《川北醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討高強(qiáng)度聚焦超聲(HIFU)對子宮肌瘤患者圍手術(shù)期應(yīng)激及免疫功能的影響。方法:選取2016年6月至2016年12月在川北醫(yī)學(xué)院附屬醫(yī)院婦產(chǎn)科就診并經(jīng)臨床及影像學(xué)檢查確診的子宮肌瘤患者87例為研究對象,根據(jù)患者的治療意愿分別將患者分為高強(qiáng)度聚焦超聲(HIFU)治療組(觀察組)、腹腔鏡下子宮肌瘤剔除術(shù)組(對照組)和經(jīng)腹子宮肌瘤剔除術(shù)組(對照組),其中HIFU組38例,腹腔鏡組29例,經(jīng)腹組20例。分別于術(shù)前24h內(nèi)及術(shù)后24h抽取患者肘靜脈血,采用流式細(xì)胞術(shù)檢測外周血CD4+、CD8+T淋巴細(xì)胞比例,并計(jì)算CD4+/CD8+比值;酶聯(lián)免疫吸附法(ELISA)檢測血漿IL-2、IL-10濃度;血細(xì)胞分析儀檢測白細(xì)胞計(jì)數(shù)及中性粒細(xì)胞百分比。比較三組間及組內(nèi)各檢測指標(biāo)術(shù)前及術(shù)后24h的變化。結(jié)果:(1)三組患者之間術(shù)后24h外周血CD4+T淋巴細(xì)胞比例及CD4+/CD8+比值相比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),其中,腔鏡組及經(jīng)腹組術(shù)后CD4+T淋巴細(xì)胞比例及CD4+/CD8+比值明顯低于HIFU組,結(jié)果有明顯差異(P0.05);腔鏡組和經(jīng)腹組術(shù)后CD4+T細(xì)胞比例及CD4+/CD8+比值比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。三組患者之間術(shù)后24h CD8+T細(xì)胞比例的比較,結(jié)果未見明顯差異(P0.05)。各組內(nèi)比較,腹腔鏡組和開腹組術(shù)后CD4+、CD8+T淋巴細(xì)胞比例及CD4+/CD8+比值均較術(shù)前降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);HIFU組術(shù)后CD4+、CD8+T細(xì)胞比例及CD4+/CD8+比值較術(shù)前無明顯變化,結(jié)果無明顯差異(P0.05)。(2)三組患者間術(shù)后24h血漿IL-2、IL-10水平比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),其中,HIFU組術(shù)后24h血漿IL-2水平明顯高于腔鏡組及經(jīng)腹組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),腔鏡組和經(jīng)腹組比較,結(jié)果無明顯差異(P0.05);經(jīng)腹組術(shù)后24h血漿IL-10水平明顯高于HIFU組及腔鏡組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),腔鏡組和HIFU組比較,結(jié)果無差異(P0.05)。各組內(nèi)比較,HIFU組術(shù)后24h血漿IL-2水平較術(shù)前升高(P0.05),腔鏡組和開腹組術(shù)后IL-2水平較術(shù)前降低,結(jié)果有明顯差異(P0.05);開腹組術(shù)后24h血漿IL-10濃度較術(shù)前升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),HIFU組和腔鏡組術(shù)后IL-10濃度較術(shù)前無明顯變化(P0.05)。(3)三組患者間術(shù)后白細(xì)胞計(jì)數(shù)及中性粒細(xì)胞百分比各不相同,經(jīng)腹組最高,腔鏡組次之,HIFU組最低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。各組內(nèi)比較,三組患者術(shù)后白細(xì)胞計(jì)數(shù)及中性百分比較術(shù)前均不同程度升高,其中經(jīng)腹組升高最明顯,腔鏡組次之,HIFU組升高幅度最小,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:(1)高強(qiáng)度聚焦超聲(HIFU)治療子宮肌瘤在圍手術(shù)期引起患者機(jī)體的應(yīng)激反應(yīng)較開腹組和腔鏡組輕,創(chuàng)傷小。(2)HIFU治療子宮肌瘤可能在一定程度上增強(qiáng)機(jī)體圍手術(shù)期的細(xì)胞免疫功能,是一種更為安全、微創(chuàng)的治療方式。
[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.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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