完全腔镜甲状腺切除术治疗原发性甲亢的创伤反应  

The systemic inflammatory response to trauma in primary hyperthyroidism patients after endoscopic bilateral subtotal thyroidectomy

作　　者：赖勇强[1] 梁伟新[1] 朱明章[1] 黄永良[1] 李志宏[1] 苏秀梅[1] LAI Yongqiang LIANG Weixin ZHU Mingzhang HUANG Yongliang LI Zhihong SU Xiumei(Department of General Surgery, Gaoming People＇s Hospital in Foshan City, Foshan city, Guangdong province 528500, China)

机构地区：[1]佛山市高明区人民医院外一科,广东佛山528500

出　　处：《岭南现代临床外科》2017年第1期77-80,共4页Lingnan Modern Clinics in Surgery

基　　金：佛山市医学类科技攻关项目(2016AB001264)

摘　　要：目的分析原发性甲亢患者术后的创伤反应变化。方法资料来源于2015年10月~2016年10月确诊为原发性甲亢行手术治疗的病例,其中18例经胸乳入路腔镜下双侧甲状腺次全切除(ET组),35例行传统开放切口的双侧甲状腺次全切除术(COT组)。测定术前2 h和术后24 h创伤反应指标:血超敏C反应蛋白(Hs-CRP)、肿瘤坏死因子α(TNF-α)和白介素6(IL-6),术后72 h内评估是否合并发全身炎症反应综合症(SIRS),比较两组3个应激指标及术后合并SIRS的例数。结果腔镜经胸乳入路组手术时间较开放组长,而术后住院天数少于对照组,两组术中出血量、术后引流量无显著性差异。两组均无严重副损伤和并发症。两种术式术后24 h血Hs-CRP、TNF-α、IL-6水平均较术前明显升高(P<0.001)。但两组3个创伤反应指标的变化值△Hs-CRP、△TNF-α和△IL-6比较,差异无统计学意义(P>0.05)。两组术后并发SIRS例数无显著性差异(P>0.05)。结论与传统开放手术相比,完全腔镜甲状腺切除术治疗原发性甲亢手术时间较传统开放组长,术后住院时间缩短,安全性类似,引起机体的创伤反应无显著性差异,对于合适的病例可选择应用。Objective To evaluate the response to trauma in primary hyperthyroidism patientswho underwent endoscopic thyroidectomy via breast approach. Methods Fifty-three patients with prima-ry hyperthyroidism patients,admitted from Oct 2015 to Oct 2016 and underwent bilateral subtotal thy-roidectomy,were assigned endoscopic thyroidectomy via breast approach group（ET,n=18）,and con-ventional open thyroidectomy group（COT,n=35）. The responses to trauma were measured,includingHs-CRP,TNF-α and IL-6 in peripheral blood at 2 hours pre-operation and 24 hours post-operation. Thesystemic inflammatory response syndrome（SIRS）was assessed in two groups. Results The postopera-tive values of Hs-CRP,TNF-α and IL-6 were higher than preoperative values in ET group,as same as inCOT group. However,the changes（△Hs-CRP,△TNF-α and △IL-6）before and after operation in twogroups were no significant difference（P〈0.05）. And the morbidity of post-operation SIRS was approxi-mate within the two different surgery ways（P〈0.05）. Conclusion Both the endoscopic thyroidectomyand conventional open thyroidectomy caused patients trauma-associated inflammatory response. But therewas no significant difference of the trauma effect between ET group and COT group. It is optional surgeryfor appropriate patients.

关 键 词：原发性甲亢 双侧甲状腺次全切除 腔镜 创伤反应 

分 类 号：R653[医药卫生—外科学]