【摘要】 目的探讨腹腔镜手术对子宫肌瘤患者体内蛋白质氧化、脂质过氧化的影响。方法将40例子宫肌瘤患者随机分为腹腔镜组和开腹组两组,每组20例。测定两组患者腹腔镜手术前、手术结束时(气腹解除后5min)及术后24h血浆晚期氧化蛋白产物(AOPP)、丙二醛、血浆谷胱甘肽过氧化物酶(GPx)活性和血浆总抗氧化能力(AOA)的水平,以及开腹手术术前、手术结束(缝合腹壁时)及术后24h的水平。结果(1)腹腔镜组手术结束时血浆AOPP、丙二醛水平高于术前[(69±13)μmol/Lvs(50±9)μmol/L,P<001;(252±055)μmol/Lvs(185±019)μmol/L,P<001],血浆GPx活性、AOA水平低于术前[(029±009)U/mlvs(062±027)U/ml,P<001;(090±024)mmol/Lvs(141±039)mmol/L,P<001];术后24h血浆AOPP、丙二醛、GPx与术前比较差异无统计学意义[(50±10)μmol/L,P>005;(205±068)μmol/L,P>005;(052±006)U/ml,P>005],但AOA水平仍低[(100±031)mmol/L,P<001]。(2)开腹组手术结束时血浆AOPP、丙二醛含量比术前略有升高[(53±100μmol/Lvs(52±70)μmol/L,P>005;(209±051)μmol/Lvs(183±064)μmol/L,P>005],GPx活性、AOA水平比术前略有下降[(051±017)U/mlvs(057±021)U/ml,P>005;(120±046)mmol/Lvs133±037,P>005];术后24h血浆AOPP、丙二醛与术前相比升高[更多还原

【Abstract】 Objective To evaluate the effect of laparoscopic surgery on and lipid hyperoxidation in patients with hysteromyoma. Methods Forty patients with hysteromyoma were randomly divided into 2 equal groups: laparoscopy group and laparotomy group. The plasma advanced oxidation protein products(AOPP), malondialdehyde (MDA), antioxidant activity (AOA), and glutathione peroxidase (GPx) activity were measured before operation, just after operation (5 minutes after deflation)and 24 hours after operation. Results (1) In the laparoscopy group, the levels of AOPP and MDA were (50.20±9.23) μmol/L and (1.85±0.19) μmol/L before operation, increased significantly just after operation [(68.75±12.69) μmol/L and (2.52±0.55) μmol/L respectively, both P<0.01], and recovered to the normal level 24 hour postoperatively [(49.70±9.92) μmol/L and (2.05±0.68) μmol/L respectively, both P>0.05]. The levels of GPx and AOA decreased significantly just after operation [(0.29±0.09) U/ml vs. (0.62±0.27) U/mL and (0.90±0.24) mmol/L vs. (1.41±0.39) mmol/L respectively,both P<0.01], and the GPx level recovered 24 hours after operation [(0.52±0.06) U/mL,P>0.05], however, the AOA level was still lower [(1.00±0.31) mmol/L,P<0.01]. In the laparotomy group, the levels of plasma AOPP and MDA level slightly increased just after operation in comparison with those before operation [(53.39±9.86) μmol/L vs. (52.30±7.10) μmol/L and (2.09±0.51) μmol/L vs. (1.83±0.64) μmol/L respectively, both P>0.05] and continued to increase 24 hours after operation [(63.40±15.5) μmol/L,P<0.05, and (2.42±0.44) μmol/L,P<0.01]; the GPx and AOA levels decreased a little just after operation [(0.51±0.17) U/mL vs. (0.57±0.21) U/mL and (1.20±0.46) mmol/L vs. (1.33±0.37) mmol/L,both P>0.05] and continued to decrease 24 hours after operation [(0.35±0.19) U/mL and (0.92±0.22) mmol/L respectively,both P<0.01]. Compared with those of the laparotomy group, the plasma AOPP and MDA levels of the laparoscopy group were both significantly lower(P<0.01 and P<0.05), and the GPx level was significantly higher(P<0.01)24 hours after operation, however, the AOA level was not significantly different (P>0.05). Conclusion Laparoscopic surgery is better than laparotomy. Protein oxidation and lipid hyperoxidation occur during the laparoscopic surgery, however, disappeared after operation. Free radicals are generated by the end of laparoscopic procedure, possibly as a result of an ischemia-reperfusion phenomenon induced by the inflation and deflation of the pneumoperitoneum. AOPP and MDA are induced during laparoscopic procedure and then return to the normal levels finally.更多还原