经腋窝入路腔镜与传统开放式甲状腺癌根治术对患者炎性因子水平影响  

Effects of transaxillary approach endoscopic and traditional open radical thyroidectomy on the levels of inflammatory factors in patients with thyroid cancer

作　　者：马震[1] 潘金强[1] 冯涛[1] 耿中利[1] 王薇[1] Ma Zhen;Pan Jinqiang;Feng Tao;Geng Zhongli;Wang Wei(Second Department of General Surgery,Xinjiang Medical University Hospital of Chinese Medicine,Urumqi 830000,China)

机构地区：[1]新疆医科大学附属中医医院普外二科,乌鲁木齐830000

出　　处：《中国医师进修杂志》2022年第11期1004-1009,共6页Chinese Journal of Postgraduates of Medicine

基　　金：新疆维吾尔自治区自然科学基金(2022D01C175)。

摘　　要：目的探讨经腋窝入路腔镜与传统开放式甲状腺癌根治术对甲状腺癌患者炎性因子水平的影响。方法回顾性分析新疆医科大学附属中医医院2019年10月至2021年10月102例行手术治疗的甲状腺癌患者的临床资料。其中,行经腋窝入路腔镜甲状腺癌根治术50例(研究组),行开放式甲状腺癌根治术52例(对照组)。比较两组手术相关指标,包括手术时间、术中失血量、术后引流量、淋巴结清扫数、住院时间;记录术后1、3和7 d疼痛评分;于术前和术后1 d采用酶联免疫吸附试验法检测白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、半乳糖凝集素-3(Gal-3)、肿瘤坏死因子-α(TNF-α)水平;记录术后并发症,包括声音嘶哑、肢体麻木、饮水呛咳和低钙血症;出院后3个月随访美容满意度,出院后6个月复查CT观察复发情况。结果研究组手术时间明显长于对照组[(88.69±15.16)min比(61.47±15.48)min],但术中失血量、术后引流量和住院时间明显小于对照组[(51.21±10.06)ml比(85.46±11.37)ml、(98.29±30.61)ml比(117.47±30.25)ml和(5.35±0.54)d比(7.72±0.61)d],差异有统计学意义(P<0.01);两组淋巴结清扫数比较差异无统计学意义(P>0.05)。研究组术后1和3 d疼痛评分明显低于对照组[(5.13±1.07)分比(7.87±1.46)分和(4.22±1.35)分比(6.42±1.28)分],差异有统计学意义(P<0.05);两组术后7 d疼痛评分比较差异无统计学意义(P>0.05)。两组术前IL-6、IL-10、TNF-α和Gal-3比较差异无统计学意义(P>0.05);研究组术后1 d IL-6、IL-10、TNF-α和Gal-3明显低于对照组[(26.27±3.14)ng/L比(29.22±4.52)ng/L、(7.54±2.31)ng/L比(10.92±2.54)ng/L、(14.98±3.76)μg/L比(23.65±2.46)μg/L和(3.54±0.48)μg/L比(4.48±0.63)μg/L],差异有统计学意义(P<0.01)。两组总并发症发生率比较差异无统计学意义(χ^(2)=1.73,P>0.05)。研究组总满意度明显高于对照组[94.0%(47/50)比78.8%(41/52)],差异有统计学意义(χ^(2)=4.94,P<0.05)。两组患者�Objective To investigate the effects of transaxillary endoscopic and traditional open radical thyroidectomy on the levels of inflammatory factors in patients with thyroid cancer.Methods The clinical data of 102 thyroid cancer patients underwent radical thyroidectomy from October 2019 to October 2021 in Xinjiang Medical University Hospital of Chinese Medicine were retrospectively analyzed.Among them,50 cases underwent transaxillary approach endoscopic radical thyroidectomy(study group),and 52 cases underwent open radical thyroidectomy(control group).The operation related indexes were compared between two groups,including operation time,intraoperative blood loss,postoperative drainage,lymph node clearance and hospital stay;the pain scores 1,3 and 7 d after operation were recorded;the levels of interleukin-6(IL-6),interleukin-10(IL-10),galectin-3(Gal-3)and tumor necrosis factor-α(TNF-α)before operation and 1 d after operation were measured by enzyme-linked immunosorbent assay;the postoperative complications were recorded,including hoarseness,limb numbness,cough after drinking water and hypocalcemia;and the cosmetic satisfaction was followed up 3 months after discharge,and the recurrence was observed by CT 6 months after discharge.Results The operation time in study group was significantly longer than that in control group:(88.69±15.16)min vs.(61.47±15.48)min,while the intraoperative blood loss,postoperative drainage and hospital stay were significantly lower in control group:(51.21±10.06)ml vs.(85.46±11.37)ml,(98.29±30.61)ml vs.(117.47±30.25)ml and(5.35±0.54)d vs.(7.72±0.61)d,and there were statistical differences(P<0.01);there was no statistical difference in lymph node clearance between two groups(P>0.05).The pain score 1 and 3 d after operation in study group was significantly lower than that in control group:(5.13±1.07)scores vs.(7.87±1.46)scores and(4.22±1.35)scores vs.(6.42±1.28)scores,and there were statistical differences(P<0.05);there was no statistical difference in pain score 7 d after opera

关 键 词：甲状腺肿瘤 经腋窝入路腔镜 开放手术 炎性因子 

分 类 号：R736.1[医药卫生—肿瘤]