不同方式甲状腺切除术对甲状腺病人甲状腺功能、免疫功能和生活质量的影响  

Effects of three kinds of thyroid surgery on thyroid function,immune function and quality of life in patients

作　　者：李阳 卢伟燕 陈伟 张雷 杨晓峰 姜玉石 LI Yang;LU Weiyan;CHEN Wei;ZHANG Lei;YANG Xiaofeng;JIANG Yushi(Department of General Surgery China National Petroleum Corporation Center Hospital,Langfang,Hebei 065000,China)

机构地区：[1]河北中石油中心医院普外科,河北廊坊065000

出　　处：《安徽医药》2020年第10期2018-2023,共6页Anhui Medical and Pharmaceutical Journal

基　　金：廊坊市科技支撑计划项目(2017013055)。

摘　　要：目的探讨三种甲状腺手术方式对甲状腺单发结节治疗的临床效果以及对病人的甲状腺功能和免疫功能与生活质量的影响。方法选取2014年6月至2017年6月在河北中石油中心医院接受腔镜辅助小切口(EAT)治疗的30例病人为研究对象,选取同期行完全腔镜甲状腺切除术(TET)治疗30例以及传统手术(传统组术)的30例病人进行对比分析。观察三组病人手术一般情况,比较三组病人术前和术后第1、3、5天甲状腺激素的游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)和免疫球蛋白M(IgM)、免疫球蛋白G(IgG)和免疫球蛋白A(IgA)的差异以及采用Karnofsky量表评估病人手术前后生活质量的差别。结果三组病人的手术时间无明显差别;EAT组和TET组的术中出血量较传统组少,三组出血量分别为(20.25±2.23)、(20.28±2.15)和(38.48±3.21)mL;术后住院时间较传统组(8.25±1.02)d短,而EAT组(5.84±0.95)d和TET组(6.12±0.86)d间的差异无统计学意义(P>0.05)。三组病人术前1天血清中的FT3、FT4和TSH水平无差别,术后第1天,传统组FT3和FT4分别为(4.20±0.46)和(16.91±2.15)pmol/L、ETA组为(4.55±0.44)和(17.49±1.57)pmol/L、TET组为(4.58±0.43)和(18.21±1.76)pmol/L,术后第3天,传统组分别为(3.59±0.46)和(14.66±1.79)pmol/L、ETA组为(4.14±0.32)和(16.40±1.86)pmol/L、TET组为(4.27±0.40)和(16.53±1.92)pmol/L,术后第5天,传统组分别为(3.61±0.60)和(12.49±1.93)pmol/L、ETA组为(4.20±0.30)和(15.87±1.99)pmol/L、TET组为(4.26±0.39)和(15.37±2.26)pmol/L,EAT组和TET组的FT3和FT4的水平均高于传统组(P<0.05),而EAT和TET两组间比较无差别(P>0.05);术后第3天和第5天传统组TSH为(4.22±2.29)和(7.63±3.59)m Iu/L,ETA组为(2.16±0.76)和(2.98±0.99)mIu/L,TET组为(2.23±0.60)和(3.45±0.76)m Iu/L,发现在术后第3天开始EAT组和TET组的TSH水平均低于传统组(P<0.05),而EAT和TET两组间比较无差别(P>0.05)。三组病人术前和术后第1天�Objective To investigate the therapeutic effect of three kinds of thyroid surgery on the treatment of single thyroid nodule and the influence on thyroid function,immune function and quality of life.MethodsThirty patients with single thyroid nodule who underwent laparoscopic assisted small incision(EAT)in Hebei Petrochina Central Hospital from June 2014 to June 2017 were selected as the study objects(study group),and 30 patients treated by totally endoscopic thyroidectomy(TET group)and 30 patients treated by traditional surgery(traditional group)during the same period were selected for comparative analysis,30.The general operation conditions of the three groups of patients were observed.The levels of free tri-iodothyronine(FT3),free thyroxine(FT4)and thyroid-stimulating hormone(TSH)of the thyroid hormones in the three groups before operation and at 1,3,and 5 days after operation,immunoglobulin M(IgM),immunoglobulin G(IgG)and immunoglobulin A(IgA),and the difference in quality of life before and after surgery using the Karnofsky scale were compared among the three groups.ResultsThe operation time showed no significant difference between EAT group and TET group(P>0.05);The intra-operative blood loss in the EAT group and the TET group was less than that in the subtotal thyroidectomy group,and the blood loss in the three groups was(20.25±2.23),(20.28±2.15)and(38.48±3.21)mL,respectively.The postoperative hospital stay was shorter than that in the subtotal thyroidectomy group(8.25±1.02)days,while there was no significant difference between the EAT group(5.84±0.95)days and the TET group(6.12±0.86)days(P>0.05).There were no differences in serum levels of FT3,FT4 and TSH among the three groups before surgery(P>0.05).On the first day after surgery,the levels of FT3 and FT4 were(4.20±0.46)and(16.91±2.15)pmol/L in the subtotal thyroidectomy group,(4.55±0.44)and(17.49±1.57)pmol/L in the ETA group,and(4.58±0.43)and(18.21±1.76)pmol/L in the TET group.On the third day after surgery,the levels of FT3 and FT4 were(3.59�

关 键 词：甲状腺肿瘤/外科学 内窥镜检查 甲状腺功能 免疫功能 生活质量 腹腔镜检查 

分 类 号：R653[医药卫生—外科学]