改良微创腔镜小切口手术治疗甲状腺微小癌的效果  

Effect of improved minimally invasive endoscopic surgery with small incision in the treatment of thyroid microcarcinoma

作　　者：王浩[1] 邹燕 WANG Hao;ZOU Yan(Department of Thyroid and Breast Surgery,Zigong Fourth People′s Hospital in Sichuan Province,Zigong,Sichuan,643000)

机构地区：[1]四川省自贡市第四人民医院甲状腺乳腺外科,四川自贡643000

出　　处：《实用临床医药杂志》2024年第16期10-14,共5页Journal of Clinical Medicine in Practice

基　　金：2020年四川省医学(青年创新)科研课题(S2001A)。

摘　　要：目的观察改良微创腔镜小切口手术治疗甲状腺微小癌(TMC)的效果。方法选取108例TMC患者为研究对象,并随机分为对照组和研究组,每组54例。对照组采用常规腔镜甲状腺切除术治疗,研究组采用改良微创腔镜小切口手术治疗。比较2组的围术期情况、手术前后炎症-应激因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、丙二醛(MDA)、皮质醇(Cor)]水平、Wnt/β-catenin通路指标表达水平、术后并发症发生率、美容效果以及术后复发率。结果研究组手术时间、住院时间、术后引流量短于或少于对照组,差异有统计学意义(P<0.05)。术后第1、3天,研究组血清IL-6、CRP、MDA和Cor水平低于对照组,差异有统计学意义(P<0.05);术后第1、3天,研究组外周血单个核细胞中Wnt1 mRNA、β-catenin mRNA表达水平低于对照组,差异有统计学意义(P<0.05)。2组并发症发生率、术后复发率比较,差异无统计学意义(P>0.05)。研究组美容满意度为90.74%,高于对照组的75.93%,差异有统计学意义(P<0.05)。结论采用改良微创腔镜小切口手术治疗TMC患者,可有效减轻患者手术创伤,显著降低术后短期内炎症-应激因子水平,抑制Wnt/β-catenin通路活性,提高美容效果。Objective To observe the effect of modified minimally invasive endoscopic small incision surgery in treatment of thyroid microcarcinoma(TMC).Methods A total of 108 patients with TMC were selected as the research subjects and randomly divided into control group and study group,with 54 patients in each group.The control group was treated with conventional endoscopic thyroidectomy,while the study group received modified minimally invasive endoscopic small incision surgery.The perioperative conditions,levels of inflammatory and stress factors[interleukin-6(IL-6),C-reactive protein(CRP),malondialdehyde(MDA)and cortisol(Cor)],expression levels of Wnt/β-cateninpathway indicators,postoperative complication rate,cosmetic effect and postoperative recurrence rate were compared between the two groups.Results The operation time,hospitalization time and postoperative drainage volume in the study group were shorter or less than those in the control group(P<0.05).On the 1st and 3rd days after surgery,the serum levels of IL-6,CRP,MDA and Cor in the study group were lower than those in the control group,with statistically significant differences(P<0.05).On the 1st and 3rd postoperative days,the expression levels of Wnt1 mRNA andβ-catenin mRNA in peripheral blood mononuclear cells of the study group were lower than those in the control group(P<0.05).There was no significant difference in the complication rate and postoperative recurrence rate between the two groups(P>0.05).The cosmetic satisfaction rate in the study group was 90.74%,which was higher than 75.93%in the control group,indicating a statistically significant difference(P<0.05).Conclusion The use of modified minimally invasive endoscopic small incision surgery in the treatment of TMC patients can effectively relieve surgical trauma,significantly reduce the levels of inflammatory and stress factors in a short time after surgery,inhibit the activity of the Wnt/β-catenin pathway,and improve cosmetic results.

关 键 词：甲状腺微小癌 改良微创腔镜小切口手术 炎症因子 应激因子 WNT/Β-CATENIN通路 并发症 复发 

分 类 号：R581[医药卫生—内分泌] R446[医药卫生—内科学] R61[医药卫生—临床医学]