经胸乳腔镜手术治疗甲状腺乳头状癌的临床效果分析  

Clinical effectiveness of endoscopic surgery using a chest-breast approach for thyroid papillary cancer

作　　者：丁朦燕 郭新海 赵罕胤 Ding Mengyan;Guo Xinhai;Zhao Hanyin(Department of Thyroid Surgery,Zhoushan Hospital,Zhoushan 316000,Zhejiang Province,China)

机构地区：[1]舟山医院甲状腺外科,舟山316000

出　　处：《中国基层医药》2024年第6期841-845,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨经胸乳腔镜手术治疗甲状腺乳头状癌(PTC)的效果及对患者应激反应和疼痛递质影响。方法回顾性分析舟山医院2022年1月至2023年1月收治的PTC患者100例,依据手术方法分为腔镜组与传统手术组,各50例。腔镜组行经胸乳腔镜手术治疗,传统手术组行传统开放手术治疗。比较两组手术指标,并发症发生情况以及术前和术后5 d甲状腺功能,应激反应和疼痛递质变化。结果腔镜组手术时间长于传统手术组[(147.84±27.95)min比(112.31±23.16)min],术中出血量少于传统手术组[(20.81±4.24)mL比(37.74±6.56)mL],术后引流量少于传统手术组[(32.34±6.84)mL比(47.96±12.31)mL],术后住院时间短于传统手术组[(4.06±1.31)d比(6.87±1.54)d](t=6.92、15.33、7.84、9.83,均P<0.001)。腔镜组患者术后并发症发生率低于传统手术组(6.00%比20.00%)(χ^(2)=4.33,P=0.037)。术后5 d,腔镜组患者三碘甲状腺原氨酸(T_(3))和甲状腺素(T_(4))均低于传统手术组,而促甲状腺激素(TSH)高于传统手术组(t=5.57、8.69、10.17,均P<0.001)。术后5 d,腔镜组患者皮质醇(Cor)和丙二醛(MDA)均低于传统手术组(t=9.31、17.21,均P<0.001)。术后5 d,腔镜组患者P物质(SP)、神经肽Y(NPY)和前列腺素E_(2)(PGE_(2))水平均低于传统手术组(t=9.84、13.65、10.94,均P<0.05)。结论经胸乳腔镜手术治疗PTC的效果显著,并发症少,甲状腺功能改善明显,应激反应小,并可抑制疼痛递质释放。Objective To investigate the efficacy of endoscopic surgery using a chest-breast approach for thyroid papillary cancer and its effect on stress response and pain transmitters.Methods A total of 100 patients with thyroid papillary cancer who received treatment at Zhoushan Hospital between January 2022 and January 2023 were retrospectively included in this study.These patients were divided into an endoscopic surgery group and a traditional surgery group according to the surgical method used,with 50 patients in each group.The endoscopic surgery group received endoscopic surgery,while the traditional surgery group underwent traditional open surgery.Surgical indicators,postoperative complications,thyroid function measured before surgery and 5 days after surgery,stress response,and pain transmitters were compared between the two groups.Results The operative time in the endoscopic surgery group was longer than that in the traditional surgery group[(147.84±27.95)minutes vs.(112.31±23.16)minutes,t=6.92,P<0.001].Intraoperative blood loss in the endoscopic surgery group was less than that in the traditional surgery group[(20.81±4.24)mL vs.(37.74±6.56)mL,t=15.33,P<0.001].Postoperative drainage amount in the endoscopic surgery group was significantly less than that in the traditional surgery group[(32.34±6.84)mL vs.(47.96±12.31)mL,t=7.84,P<0.001].Postoperative length of hospital stay in the endoscopic surgery group was significantly shorter than that in the traditional surgery group[(4.06±1.31)days vs.(6.87±1.54)days,t=9.83,P<0.001].The incidence of postoperative complications in the endoscopic surgery group was significantly lower than that in the traditional surgery group(6.00%vs 20.00%,χ^(2)=4.33,P=0.037).At 5 days post-surgery,the levels of triiodothyronine and thyroxine in the endoscopic surgery group were significantly lower than those in the traditional surgery group,while the level of thyroid stimulating hormone was significantly higher(t=5.57,8.69,10.17,all P<0.001).At 5 days post-surgery,the levels of corti

关 键 词：胸腔镜检查 外科手术 甲状腺肿瘤 癌 乳头状 手术后并发症 氧化性应激 

分 类 号：R736.1[医药卫生—肿瘤]