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Objective:To investigate the effect of etomidate combined with transversus abdominis plane block (TAPB) on serum inflammatory factors and immune function indexes in patients after total hysterectomy.Methods:The study included 86 patients who underwent transabdominal total hysterectomy from Jan. 2020 to Jan. 2023. They were divided into group A (44 cases) and group B (42 cases) according to the random number table method. Group A received general anesthesia (propofol for anesthesia maintenance) + TAPB anesthesia, and group B received general anesthesia (propofol combined with etomidate for anesthesia maintenance) + TAPB anesthesia. The changes of heart rate (HR) and mean arterial pressure (MAP) at different time points were observed in the two groups. The serum related factors [interleukin-6 (IL-6) , tumor necrosis factor-α (TNF-α) ] and immune function indexes (T lymphocyte subsets CD3 +, CD4 +, CD4 +/CD8 +) were compared between the two groups before anesthesia and 24 h after operation. The complications of the two groups after anesthesia were counted. Results:HR and MAP of the two groups were gradually increased at T1 and T2 compared with those at T0, and gradually decreased at T3 and T4 compared with those at T2. The serum levels of IL-6 and TNF-α in the two groups at 24 h after operation were higher than those before anesthesia. The levels of IL-6 and TNF-α in group B were (261.17±33.67) ng/L and (12.37±2.57) ng/L, lower than those in group A (287.89±45.71) ng/L and (16.46±3.78) ng/L ( P<0.05) . The levels of CD3 +, CD4 + and CD4 +/CD8 + in the two groups were lower than those before anesthesia. The levels of CD3 +, CD4 + and CD4 +/CD8 + in group B were (65.26±4.67) %, (27.83±2.59) % and (1.48±0.35) , higher than those in group A (62.17±3.85) %, (26.25±2.16) % and (1.32±0.21) ( P<0.05) . There was no significant difference in the total incidence of complications after anesthesia between the two groups (13.64% in group A and 7.21% in group B) ( P>0.05) . Conclusions:The application of etomidate combined with TAPB anesthesia in total abdominal hysterectomy can inhibit the inflammatory response caused by surgical trauma, maintain the stability of postoperative immune function,without increasing the impact on hemodynamics of patients, or the incidence of complications.
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Objective To compare the effects of transabdominal hysterectomy(TAH),transvaginal hysterectomy(TVH),and laparoscopic total hysterectomy(LTH)on sexual function and psychological health.Methods A total of 100 patients undergoing TAH,100 patients undergoing TVH,and 40 patients undergoing LTH were followed up for 1 year.All the patients were aged between 45 and 54 years.The Results of the questionnaire on sexual function and psychological health were analyzed and compared with those from 100 control subjects undergoing hysteromyomectomy.Results In pateints under 50 years of age,no significant difference in the sexual function and psychological health was found between control group and any one of TAH,TVH,and LTH goups.In patients aged 50 yeare and older.ESFI score decreased from control group to TVH group to LTH group to TAH group;CHQ-12 score increased from control group to TVH group to LTH group to TAH group;and there was significant difference in the FSFI and CHQ-12 scores both between TAH and control groups and between TAH and TVH groups(P＜0.05).Conclusion There is no obvious effect of these 3 surgical approches to hysterectomy on the sexual function and psychological health in patients under 50 years of age,and there is no significant difference in the sexual function and psychological health among these 3 surgcial approaches.In patients aged 50 yean;and older,TAH has a negative impact on the psychological health and sexual function.
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Objective To compare the effects of transabdominal hysterectomy(TAH),transvaginal hysterectomy(TVH),and laparoscopic assisted vaginal hysterectomy(LAVH).Methods Clinical data of 48 cases of TAH(TAH Group),38 cases of TVH(TVH Group),and 31 cases of LAVH(LAVH Group) were retrospectively analyzed.Results The operation time was shorter in the TAH Group(73.7?5.9 min) than in the TVH Group(80.9?7.0 min) and the LAVH Group(129.3?9.1 min)(F=612.04,P=0.000).The intraoperative blood loss was greater in the LAVH Group(142.8?17.1 ml) than in the TAH Group(128.1?9.6 ml) and the TVH Group(129.7?10.2 ml)(F=15.18,P=0.000).The postoperative analgesic requirement rate was higher in the TAH Group(75.4%,36 cases) than in the TVH Group(30.2%,11 cases) and the LAVH Group(38.4%,12 cases)(?~2=20.310,P=0.000).The length of postoperative hospitalization was longer in the TAH Group(7.3?1.6 d) than in the TVH Group(4.8?1.0 d) and the LAVH Group(5.1?1.1 d)(F=47.07,P=0.000).The postoperative pyrexia rates were not significantly different among the TAH Group(8.4%,4 cases),the TVH Group(7.4%,3 cases),and the LAVH Group(8.2%,3 cases)((?~2=0.074,) P=0.964).Conclusions As compared with transabdominal hysterectomy,transvaginal hysterectomy and laparoscopic assisted vaginal hysterectomy show advantages of less invasion,less pain,and quicker recovery.