发际线切口内镜辅助下良性腮腺肿瘤切除术对术后免疫与应激反应的影响  

The immune response and surgical stress of endoscopy-assisted dissection of benign parotid tumors using hairline incision

作　　者：王洁琪[1] 钟江龙 庄沛林[1] 廖隽琨[1] 周斌[1] 范松[1] WANG Jieqi;ZHONG Jianglong;ZHUANG Peilin;LIAO Juankun;ZHOU Bin;FAN Song(Department of Stomatology,Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院口腔科,广州510120

出　　处：《实用医学杂志》2022年第22期2832-2837,共6页The Journal of Practical Medicine

基　　金：广东省基础与应用基础研究基金(编号:2021A1515220138)。

摘　　要：目的评估发际线切口内镜辅助下良性腮腺肿瘤切除术的临床结果、术后免疫反应和手术应激反应。方法47名腮腺良性肿瘤患者随机分为内镜组(n=25)和接受开放式手术的常规组(n=22)。比较两组术后并发症、引流量、疼痛评分及外观满意度,并检测术后12 h(T1),24 h(T2),72 h(T3)的IL-6、IL-8、IL-10、IL-1β、TNF-α、C反应蛋白、皮质醇、促肾上腺皮质激素和生长激素水平,评估手术方式对免疫反应和手术应激的影响。结果内镜组切口长度显著短于常规组(P<0.001),内镜组术中出血量显著低于常规组(P=0.004),内镜组患者对术后美容效果的满意度高于常规组(P=0.027)。内镜组术后引流量显著高于常规组(P=0.024),且内镜组术后疼痛评分明显高于常规组(P=0.039)。内镜组IL-6和CRP在T1,T2,T3均平明显高于常规组(P<0.05),IL-10和皮质醇在T1,T2高于常规组(P<0.05)。结论发际线切口内镜辅助下切除腮腺良性肿瘤可改善术后美容效果。内镜手术导致更剧烈的术后疼痛和更大的引流量,免疫反应及手术应激反应也更强烈。Objective To assess the clinical outcomes,postoperative immune response,and surgical stress of endoscope-assisted dissection for benign parotid tumors using hairline incision.Methods 47 patients with benign parotid tumors were enrolled and randomly divided into two groups.The patients in the endoscopy group(n=25)underwent endoscopic-assisted dissection using hairline incision,while those in the control group(n=22)underwent conventional open surgery.The postoperative complications,drainage,pain scores and satisfaction of aesthetic outcomes were compared,and serum concentrations of IL-6,IL-8,IL-10,IL-1β,TNF-α,CRP,cortisol,ACTH and growth hormone were detected 12 hours(T1),24 hours(T2)and 72 hours(T3)after the procedure.The impacts of the procedure modes on postoperative immune response and surgical stress were assessed.Results The incision length in the endoscopy group was significantly shorter than that in the conventional group(P<0.001),and the intraoperative blood loss in the endoscopy group was significantly lower than that in the conventional group(P=0.004).Patients in the endoscopy group were more satisfied with the postoperative cosmetic outcomes than those in the conventional group(P=0.027).However,the postoperative drainage volume was significantly higher in the endoscopy group than in the conventional group(P=0.024),and the postoperative pain score was significantly greater in the endoscopy group than in the conventional group(P=0.039).Levels of IL-6 and CRP in the endoscopy group at T1,T2 and T3 were significantly higher than those in the conventional group(P<0.05),while levels of IL-10 and cortisol at T1 and T2 were significantly higher the endoscopy group than in the conventional group(P<0.05).Conclusions Endoscopy-assisted dissection for benign parotid tumors could improve cosmetic outcomes.Endoscopic procedures,compared with conventional surgery,resulted in a stronger inflammatory response and higher surgical stress,as well as more postoperative pain and drainage.

关 键 词：内镜手术 腮腺 免疫反应 手术应激 

分 类 号：R782.05[医药卫生—口腔医学]