颏下前庭联合入路ETS对PTC患者的临床疗效及安全性评价  

Clinical Efficacy and Safety Evaluation of Submental Vestibular Combined Approach ETS for Patients with PTC

作　　者：李明[1] 赵书华 刘忠发 曾玉剑[1] LI Ming(The First Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650300,China)

机构地区：[1]昆明医科大学第一附属医院,云南昆明650300 [2]云南省安宁市第一人民医院普外科,云南安宁650300

出　　处：《河北医学》2024年第11期1896-1902,共7页Hebei Medicine

基　　金：云南省卫生健康委临床医学中心2020-2022年建设项目,(编号:202001AF028481)。

摘　　要：目的:通过分析围手术期应激反应、术后并发症发生率,探讨颏下前庭联合入路腔镜甲状腺手术(ETS)治疗甲状腺乳头状癌(PTC)的疗效及安全性。方法:选取2020年1月至2023年10月昆明医科大学第一附属医院114例PTC患者,以随机数字表法分为两组,各57例。对照组予以口腔前庭入路ETS,观察组予以颏下前庭联合入路ETS。对比两组手术相关指标、术后疼痛程度、围手术期应激指标、甲状旁腺素(PTH)与血钙水平、免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、术后并发症发生率。结果:观察组术中出血量、术后引流量、手术时间、引流管留置及住院时间分别为(21.53±2.69)mL、(33.52±3.09)mL、(60.54±9.12)min、(2.74±0.89)d、(4.67±1.25)d,均少于对照组的(24.59±4.37)mL、(36.14±4.18)mL、(80.96±11.23)min、(3.32±1.04)d、(6.49±1.37)d,差异有统计学意义(t=4.502、3.805、10.657、3.199、7.409,P均<0.05);观察组术后4h、12h、24h、48h疼痛VAS评分分别为(2.11±0.65)分、(2.84±0.78)分、(2.34±0.78)分、(1.34±0.40)分,低于对照组的(2.63±0.80)分、(3.31±0.87)分、(2.89±0.82)分、(1.92±0.58)分,差异有统计学意义(t=3.809、3.037、3.669、6.215,P均<0.05);术后24h、72h观察组NE水平分别为(0.64±0.12)mmoL/L、(0.41±0.07)mmoL/L,低于对照组的(0.72±0.15)mmoL/L、(0.46±0.09)mmoL/L,Cor分别为(76.92±12.33)μg/L、(52.12±5.27)μg/L,低于对照组的(85.46±15.02)μg/L、(58.14±7.12)μg/L,差异有统计学意义(t=3.144、3.311、3.318、5.131,P均<0.05);术后24h、72h观察组PTH分别为(4.65±1.08)pmoL/L、(5.15±0.70)pmoL/L,高于对照组的(4.08±1.24)pmoL/L、(4.81±0.82)pmoL/L,血钙水平高于对照组分别为(2.15±0.09)mmoL/L、(2.22±0.07)mmoL/L,高于对照组的(2.04±0.12)mmoL/L、(2.17±0.09)mmoL/L,差异有统计学意义(t=2.617、2.381、5.537、3.311,P均<0.05);术后7d、1个月观察组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)分别为(61.33±4.06)%、(68.74±4.27)%、(32.94±3.02)Objective:To investigate the efficacy and safety of endoscopic thyroidectomy(ETS)through submental vestibular combined approach for the treatment of papillary thyroid carcinoma(PTC)by analyzing perioperative stress response and postoperative complication rate.Methods:A total of 114 patients with PTC from the First Affiliated Hospital of Kunming Medical University from January 2020 to October 2023 were selected and randomly divided into two groups using a random number table method,with 57 cases in each group.The control group underwent ETS through the oral vestibular approach,while the observation group underwent ETS through the submental vestibular combined approach.Surgical-related indicators,postoperative pain levels,perioperative stress indicators,parathyroid hormone(PTH)and blood calcium levels,immune function indicators(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),and postoperative complication rates were compared between the two groups.Results:The intraoperative blood loss,postoperative drainage volume,operation time,drainage tube placement,and hospitalization time in the observation group were(21.53±2.69)ml,(33.52±3.09)ml,(60.54±9.12)min,(2.74±0.89)d,and(4.67±1.25)d,respectively,which were all less than those in the control group(24.59±4.37)ml,(36.14±4.18)ml,(80.96±11.23)min,(3.32±1.04)d,and(6.49±1.37)d,with statistically significant differences(t=4.502,3.805,10.657,3.199,7.409,all P<0.05).The pain VAS scores of the observation group at 4 h,12 h,24 h,and 48 h after surgery were(2.11±0.65),(2.84±0.78),(2.34±0.78),and(1.34±0.40),respectively,which were lower than in the control group(2.63±0.80),(3.31±0.87),(2.89±0.82),and(1.92±0.58),respectively,with statistically significant differences(t=3.809,3.037,3.669,6.215,all P<0.05).The NE levels in the observation group at 24 hours and 72 hours after surgery were(0.64±0.12)mmol/L and(0.41±0.07)mmol/L,respectively,which were lower than in the control group(0.72±0.15)mmol/L and(0.46±0.09)mmol/L,and Cor values of(76.92±12.33)μg/L and(52.12±5.27)�

关 键 词：颏下前庭联合入路 甲状腺乳头状癌 腔镜甲状腺手术 疼痛 免疫功能 

分 类 号：R736.1[医药卫生—肿瘤]