摘要
目的:探讨腔镜下经口腔前庭入路甲状腺切除术在甲状腺癌中的应用效果及对术后应激反应的影响。方法:选取2018年1月—2021年1月于钦州市第一人民医院诊治的120例甲状腺癌患者为研究对象,使用随机数表法将其分为观察组(n=60)与对照组(n=60)。对照组行传统开放颈部领式切口甲状腺切除术,观察组行腔镜下经口腔前庭入路甲状腺切除术。对比两组围手术期指标、手术前后甲状腺功能指标和应激反应指标水平及并发症发生情况。结果:观察组手术时间长于对照组,术中出血量、术后第1天引流量少于对照组,术后24 h疼痛评分低于对照组,颈部活动时间、住院时间短于对照组,差异有统计学意义(P<0.05);但两组中央区淋巴结清扫数量比较,差异无统计学意义(P>0.05)。术前,两组促甲状腺激素(TSH)、三碘甲状腺原氨酸(TT_(3))、游离三碘甲状腺原氨酸(FT_(3))、四碘甲状腺原氨酸(TT_(4))、游离四碘甲状腺原氨酸(FT_(4))水平比较,差异无统计学意义(P>0.05);术后7 d,两组TSH、TT_(3)、FT_(3)水平低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);术后7 d,两组TT_(4)、FT_(4)水平均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05)。术前,两组血清皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素-2(AT-Ⅱ)、超氧化物歧化酶(SOD)水平比较,差异无统计学意义(P>0.05);术后7 d,两组SOD水平高于术前,且观察组高于对照组,差异有统计学意义(P<0.05);术后7 d,两组Cor、NE、AT-Ⅱ水平低于术前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率(8.33%)低于对照组(21.67%),差异有统计学意义(P<0.05)。结论:腔镜下经口腔前庭入路甲状腺切除术可促进甲状腺癌患者甲状腺功能恢复,并减少应激反应及并发症的发生,安全性较高。
Objective:To investigate the application effect of endoscopic transoral vestibule approach for thyroidectomy in thyroid cancer and its influence on postoperative stress response.Method:One hundred and twenty patients with thyroid cancer who treated in the First People's Hospital of Qinzhou from January 2018 to January 2021 were selected as the study objects and divided into the observation group(n=60)and the control group(n=60)using the random number table method.The control group was given traditional open neck collar incision thyroidectomy,while the observation group was given endoscopic transoral vestibule approach for thyroidectomy,the perioperative indexes,thyroid function indexes and stress response indexes before and after surgery and complications were compared between two groups.Result:The surgical time in the observation group was longer than that in the control group,the intraoperative blood loss and the drainage volume on the 1st day after surgery were less than those in the control group,the pain score at 24 h after surgery was lower than that in the control group,the neck activity time and hospitalization time were shorter than those in the control group,the differences were statistically significant(P<0.05);however,there was no significant difference in the number of central lymph node dissection between two groups(P>0.05).Before surgery,there were no statistically significant differences in the levels of thyrotropin(TSH),triiodothyronine(TT_(3)),free triiodothyronine(FT_(3)),tetraiodothyronine(TT_(4))and free tetraiodothyronine(FT_(4))between two groups(P>0.05);at 7 d after surgery,the levels of TSH,TT_(3),FT_(3) in two groups were lower than those before surgery,and those in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05);at 7 d after surgery,the levels of TT_(4) and FT_(4) in two groups were higher than those before surgery,and those in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).Before surgery,there were no significant differences in serum cortisol(Cor),norepinephrine(NE),angiotensin-2(AT-Ⅱ)and superoxide dismutase(SOD)levels between two groups(P>0.05);at 7 d after surgery,the levels of SOD in two groups were higher than those before surgery,and that in the observation group was higher than that in the control group,the differences were statistically significant(P<0.05);at 7 d after surgery,the levels of Cor,NE and AT-Ⅱin two groups were lower than those before surgery,and those in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).The complication rate in the observation group(8.33%)was lower than that in the control group(21.67%),and the difference was statistically significant(P<0.05).Conclusion:Endoscopic transoral vestibule approach for thyroidectomy can facilitate the recovery of thyroid function in patients with thyroid cancer and reduce the occurrence of stress reactions and complications,with a higher safety.
作者
黄林
劳景茂
HUANG Lin;LAO Jingmao(The First People's Hospital of Qinzhou,Qinzhou 535000,China;不详)
出处
《中外医学研究》
2023年第15期5-9,共5页
CHINESE AND FOREIGN MEDICAL RESEARCH
基金
广西壮族自治区临床重点专科建设项目(桂卫医发[2022]17号)
广西壮族自治区卫计委自筹经费科研课题项目(Z20201008)。
关键词
经口腔前庭入路甲状腺切除术
甲状腺癌
甲状腺功能
应激反应
Endoscopic transoral vestibule approach for thyroidectomy
Thyroid cancer
Thyroid function
Stress response
