腔镜辅助小切口甲状腺全切除术治疗多发结节性甲状腺肿疗效及对患者甲状腺功能和炎症反应的影响  

Effect of laparoscopic assisted total thyroidectomy with small incision on thyroid function and inflammatory response in patients with multiple nodular goiter

作　　者：杨立国 章骏[1] 赵怡[1] 张好刚[2] YANG Liguo;ZHANG Jun;ZHAO Yi;ZHANG Haogang(Shidong Hospital of Yangpu District,Shanghai 200438,China)

机构地区：[1]上海市杨浦区市东医院,上海200438 [2]哈尔滨医科大学附属第二医院,黑龙江哈尔滨150081

出　　处：《陕西医学杂志》2021年第5期568-571,582,共5页Shaanxi Medical Journal

基　　金：黑龙江省自然科学基金资助面上项目(H20180730)。

摘　　要：目的:探讨腔镜辅助小切口甲状腺全切除术治疗多发结节性甲状腺肿的疗效及对患者甲状腺功能和炎症反应的影响。方法:90例多发结节性甲状腺肿患者,按随机数字表法分为研究组(45例,给予腔镜辅助小切口甲状腺全切除术治疗)和对照组(45例,给予常规甲状腺切除术)。观察两组术中出血量、手术时间、术后第1天引流量、住院时间,比较术前、术后两组甲状腺功能指标[血清游离三碘甲状腺原氨酸(FT_(3))、促甲状腺激素(TSH)、游离甲状腺激素(FT_(4))]、炎症因子水平[C反应蛋白(CRP)、肿瘤坏死因子-(TNF-α)、白介素-6(IL-6)],统计术后两组并发症发生情况。结果:(1)研究组术中出血量、手术时间、术后第1天引流量、住院时间均低于对照组(均P<0.01)。(2)术前两组FT_(3)、TSH及FT_(4)水平比较,差异均无统计学意义(均P>0.05);术后两组FT_(3)、FT_(4)水平均降低,TSH水平升高,与术前比较差异均有统计学意义(均P<0.05);术后研究组FT_(3)、FT_(4)水平均高于对照组,TSH降低水平低于对照组,两组比较差异均有统计学意义(均P<0.01)。(3)术前,两组CRP、TNF-α、IL-6水平比较,差异均无统计学意义(均P>0.05);术后,两组CRP、TNF-α、IL-6水平均上升,与术前比较差异均有统计学意义(均P<0.05);术后研究组CRP、TNF-α、IL-6水平均低于对照组,两组比较差异均有统计学意义(均P<0.01)。(4)术后对两组进行为期6个月的随访,研究组出现1例声音嘶哑,并发症发生率为2.22%(1/45);对照组出现2例声音嘶哑、1例气管损伤及1例甲状旁腺损伤,并发症发生率为8.89%(4/45),两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论:腔镜辅助小切口甲状腺全切除术治疗多发结节性甲状腺肿对甲状腺功能水平和炎症反应影响较小,疗效好,并发症较少,安全性较高,值得临床应用。Objective:To investigate the efficacy of laparoscopic assisted total thyroidectomy with small incision in the treatment of multiple nodular goiter and its influence on patients’thyroid function and inflammatory response.Methods:A total of 90 cases of multiple nodular goiter were taken as study objects and divided into study group(45 cases were treated with laparoscopic assisted total thyroidectomy with small incision)and control group(45 cases were treated with routine thyroidectomy)according to the random number table method.The intraoperative blood loss,operation time,drainage on the first postoperative day,and length of hospital stay were observed in the two groups.The thyroid function indexes(FT_(3),TSH,FT_(4)),levels of inflammatory factors(CRP,TNF-α,IL-6),and postoperative complications were compared between the two groups.Results:Compared with the control group,the intraoperative blood loss,operation time,drainage volume on the first day after operation,and length of hospital stay in the study group were lower(all P<0.05).Preoperative comparison of FT_(3),TSH and FT_(4)between the two groups showed no significant difference(all P>0.05).After surgery,FT_(3) and FT_(4) levels in both groups were decreased,and TSH level was increased(all P<0.05).Compared with the control group,FT 3 and FT 4 levels in the study group were both higher,and TSH level was decreased(all P<0.05).Before operation,CRP,TNF-αand IL-6 levels were not significantly different between the two groups(all P>0.05).After operation,the levels of CRP,TNF-αand IL-6 in the two groups were all increased(all P<0.05).Compared with the control group,the levels of CRP,TNF-αand IL-6 in the study group were all lower(all P<0.05).Postoperative follow-up was conducted for 6 months in the two groups.1 case of hoarseness occurred in the study group,and the complication rate was 2.22%(1/45).In the control group,there were 2 cases of hoarseness,1 case of trachea injury and 1 case of parathyroid injury,and the complication rate was 8.89%(4/45).Postoperativ

关 键 词：多发结节性甲状腺肿 治疗 腔镜辅助小切口甲状腺全切除术 甲状腺功能 炎症反应 并发症 

分 类 号：R653[医药卫生—外科学]