负压创面干预对腔镜经胸乳入路甲状腺切除术后炎症水平及腔道并发症的影响  

Effect of negative pressure wound intervention on inflammation level and luminal complications after thyroidectomy through endoscopic transthoracic approach

作　　者：高峰 吕金 王子斌 卢伟燕 姜玉石 GAO Feng;LYU Jin;WANG Zibin;LU Weiyan;JIANG Yushi(General Surgery,Hebei Petro China Central Hospital,Langfang,Hebei 065000,China)

机构地区：[1]河北中石油中心医院普通外科,河北廊坊065000

出　　处：《安徽医药》2025年第5期1001-1005,共5页Anhui Medical and Pharmaceutical Journal

基　　金：廊坊市科学技术研究与发展计划项目(2021013153)。

摘　　要：目的观察负压创面干预对腔镜经胸乳入路甲状腺切除术后炎症水平及腔道并发症的影响。方法选取2021年1月至2022年3月河北中石油中心医院拟行腔镜经胸乳入路甲状腺切除术的甲状腺疾病100例,根据随机数字表法将分为治疗组和对照组,治疗组进行负压创面治疗,对照组进行常规加压包扎,每组50例。比较两组病人手术围术期指标、术后1 d、3 d和7 d的疼痛程度(VAS评分)和C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-1β、IL-10水平,采用SF-36评分评估病人术后7 d生活质量,采用温哥华瘢痕评价量表(VSS)评估术后1年瘢痕美观度。结果两组病人手术时间和术中出血量差异无统计学意义(均P>0.05)。治疗组住院时间[(4.62±0.59)d比(7.03±0.89)d]短于对照组,术后引流量[(102.71±12.95)mL比(77.29±8.56)mL]明显多于对照组(均P<0.05)。两组术前CRP、TNF-α、IL-6、IL-1β和IL-10差异无统计学意义(均P>0.05),治疗组术后1 d、3 d和7 d的CRP、TNF-α、IL-6、IL-1β水平明显低于对照组(均P<0.05),IL-10水平明显高于对照组(均P<0.05)。两组在喉返神经损伤、甲状旁腺损伤发生率差异无统计学意义(均P>0.05),但治疗组术后感染、皮下淤血和积液发生率均低于对照组(均P<0.05)。治疗组术后7 d的SF-36评分为(87.26±8.63)分,明显高于对照组的(80.43±8.03)分(t=4.10,P<0.001)。术后1年治疗组病人VSS评分(3.26±0.41)分,显著低于对照组的(4.76±0.49)分(t=−16.60,P<0.001)。结论负压创面干预可以明显减轻腔镜经胸乳入路甲状腺切除术后炎症水平,降低腔道并发症发生率,提高瘢痕美观度和生活质量,值得临床推广。Objective To observe the effect of negative pressure wound intervention on the level of inflammation and complications after thyroidectomy through endoscopic transthoracic and breast approach.Methods A total of 100 patients with thyroid disease who underwent thyroidectomy in Hebei Petro China Central Hospital from January 2021 to March 2022 were selected,who were assigned into treatment group and control group by random number table method.The treatment group received negative pressure wound treatment,and the control group received routine pressure dressing,with 50 cases in each group.Perioperative indexes,,pain degree(VAS score)at 1,3 and 7 days after surgery and C-reactive protein necrosis factor-α(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-1β,and IL-10 levels were compared between the two groups,and the SF-36 score was used to evaluate the quality of life 7 days after surgery.The Vancouver scarscale(VSS)was used to evaluate the scar appearance 1 year after surgery.Results There were no significant differences in operation time and intraoperative blood loss between the two groups(P>0.05).The length of hospital stay in the treatment group was shorter than the control group[(4.62±0.59)d vs.(7.03±0.89)d],and the postoperative drainage volume[(102.71±12.95)mL vs.(77.29±8.56)mL]was significantly more than that in the control group(P<0.05).There were no significant differences in CRP,TNF-α,IL-6,IL-1βand IL-10 between the two groups before surgery(all P>0.05).The levels of CRP,TNF-α,IL-6 and IL-1βin the treatment group were significantly lower than the control group at 1 day,3 days and 7 days after surgery(all P<0.05).IL-10 level was significantly higher than control group(all P<0.05).There were no significant differences in the incidences of recurrent laryngeal nerve injury and parathyroid injury between the two groups(P>0.05),but the incidences of postoperative cutaneous infection,subcutaneous congestion and effusion in the treatment group were lower than those in the control group(P<0.05

关 键 词：负压伤口疗法 甲状腺疾病 腔镜经胸乳入路甲状腺切除术 炎症因子 并发症 

分 类 号：R653[医药卫生—外科学]