CAJ | 학술논문

目的：分析不同子宫切除术对阴道微生态的影响，探讨不同术式对阴道免疫功能的影响。方法将300例微生态评价正常的子宫疾病患者，按手术方式分为全子宫切除组（100例）、次全子宫切除组（100例）及非子宫切除组（100例）。对三组患者术后阴道微生态系统进行再评价及对比，同时观察三组外周血清T细胞17（ Th17）的变化情况。结果①三组患者阴道微生态系统均产生不良变化（菌群密集度及多样性），其中全子宫切除组表现较为明显（P＜0．05），非子宫切除组影响程度最小；②非子宫切除中以乳酸杆菌计数为优势菌病例占93％，次全子宫切除及全子宫切除组分别为89％及60％；三组乳酸杆菌比例差异具有统计学意义（P＜0．05）；③全子宫切除术组和次全子宫切除组病原菌检出率无明显差异，但与子宫非切除术组之间差异具有统计学意义（P＜0．05）；④全子宫切除组阴道分泌物标本涂片革兰染色Nugent评分明显高于次全子宫切除组及非子宫切除术组，三组比较具有统计学差异（P＜0．05）；⑤全子宫切除组术后阴道pH≤4．5患者比例明显高于其他两组，差异有统计学意义（ P＜0．05）；⑥全子宫切除组阴道微生态功能正常为40％，次全子宫切除组为71％，非子宫切除术组为91％，三组结果统计有统计学意义（ P＜0．05）；⑦非子宫切除术组辅助性Th17百分率低于两组子宫切除组（P＜0．01），其中全子宫切除术组升高最明显。结论全子宫切除术对阴道微生态的影响较次子宫切除、非子宫切除明显，其可能与阴道免疫防御功能降低有关。
목적：분석불동자궁절제술대음도미생태적영향，탐토불동술식대음도면역공능적영향。방법장300례미생태평개정상적자궁질병환자，안수술방식분위전자궁절제조（100례）、차전자궁절제조（100례）급비자궁절제조（100례）。대삼조환자술후음도미생태계통진행재평개급대비，동시관찰삼조외주혈청T세포17（ Th17）적변화정황。결과①삼조환자음도미생태계통균산생불량변화（균군밀집도급다양성），기중전자궁절제조표현교위명현（P＜0．05），비자궁절제조영향정도최소；②비자궁절제중이유산간균계수위우세균병례점93％，차전자궁절제급전자궁절제조분별위89％급60％；삼조유산간균비례차이구유통계학의의（P＜0．05）；③전자궁절제술조화차전자궁절제조병원균검출솔무명현차이，단여자궁비절제술조지간차이구유통계학의의（P＜0．05）；④전자궁절제조음도분비물표본도편혁란염색Nugent평분명현고우차전자궁절제조급비자궁절제술조，삼조비교구유통계학차이（P＜0．05）；⑤전자궁절제조술후음도pH≤4．5환자비례명현고우기타량조，차이유통계학의의（ P＜0．05）；⑥전자궁절제조음도미생태공능정상위40％，차전자궁절제조위71％，비자궁절제술조위91％，삼조결과통계유통계학의의（ P＜0．05）；⑦비자궁절제술조보조성Th17백분솔저우량조자궁절제조（P＜0．01），기중전자궁절제술조승고최명현。결론전자궁절제술대음도미생태적영향교차자궁절제、비자궁절제명현，기가능여음도면역방어공능강저유관。
Objective To analyze the impacts of different hysterectomy on vaginal microecosystem, simultaneously discuss the influences of different operative methods on vaginal immune function.Methods 300 cases of normal microecological evaluation of hysterectomy patients in our hospital were included into the study, divided into panhysterectomy group (100 cases), subtotal hysterec-tomy group (100 cases) and the hysterectomy group (100 cases), according to the hysterectomy methods, reassessed and compared postoperative vaginal microecosystem of the three groups of patients, and observed the changes of Th17 cells in peripheral serum of the three groups.Results ①The vaginal microecosystem in three groups of patients generated disturbing changes, the changes on intensi-ty and diversity of vaginal flora in the vaginal microecosystem of panhysterectomy group were most significant than the other groups ( P<0.05);②The gram-positive big bacillus were the dominant bacteria in the vaginal bacteria of the three groups, then was gram-posi-tive coccus, the quantity of gram-positive big bacillus of the panhysterectomy group were significantly more than he other groups (P<0.05)(P<0.05);③The pathogen distribution differences of postoperative candida and trichomonas vaginalis in the three groups were with statistical significance (P<0.05);④Vaginal smear gram staining Nugent scores of specimens in the patients with panhysterectomy were significantly higher than he other groups with significant differences (P<0.05);⑤The proportion of the postoperative patients with vaginal pH≤4.5 in the subtotal hysterectomy group was obviously inferior to the patients with panhysterectomy, with statistically signif-icant differences (P<0.05);⑥The vaginal microecological function of the panhysterectomy group was 40%, that of subtotal hysterec-tomy group was 71%, the results of the three groups were with statistical significant differences (P<0.05);⑦Flow cytometry detec-tion were used to detect CD4+IL-17 +in different groups of vaginal secretions, percentage of CD4 +IL-17+cell in the subtotal hysterec-tomy group was significantly inferior to ( P<0.01) of panhysterectomy group.Conclusion The impacts of panhysterectomy on vaginal microecosystem is more obvious than hysterectomy, it may be associated with the decrease of vaginal immune defense function.