本文選題：微波消融 + 甲狀腺切除術(shù)　； 參考：《安徽醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:近年來微波消融術(shù)已經(jīng)成為治療甲狀腺良性結(jié)節(jié)新的重要方法,相對于傳統(tǒng)手術(shù),微波消融術(shù)具有恢復(fù)快、創(chuàng)傷小、切口美觀等優(yōu)點,作為一種微創(chuàng)的治療方法,越來越我被廣大患者所接受,但是作為熱消融原理治療甲狀腺良性結(jié)節(jié),其對機體仍然存在一定創(chuàng)傷,具體創(chuàng)傷程度與傳統(tǒng)手術(shù)相比缺乏臨床實驗研究。腫瘤壞死因子a(Tumor Necrosis Factor-a,TNF-a)、白介素6(Interleukin6,IL-6)、C反應(yīng)蛋白(C-reactive protein,CRP)是反映手術(shù)對機體創(chuàng)傷程度的常用指標,同時甲狀腺激素也是反映甲狀腺創(chuàng)傷后的重要指標,因此我們監(jiān)測了良性甲狀腺結(jié)節(jié)患者兩種手術(shù)(微波消融術(shù)和傳統(tǒng)切除術(shù))術(shù)前術(shù)后血清TNF-a、IL-6、CRP、血清總?cè)饧紫僭彼?TT3)、血清總甲狀腺素(TT4)、血清游離三碘甲腺原氨酸(f T3)、血清游離甲狀腺素(f T4)、促甲狀腺激素(TSH)的含量變化,并進行對比,以探討兩種治療方法對人體創(chuàng)傷的影響。方法:選擇2013年10月至2014年6月期間,南京解放軍第八一醫(yī)院普外科收治的90例診斷為良性甲狀腺結(jié)節(jié)需要手術(shù)治療,未服用任何藥物的患者,根據(jù)患者自愿分為微波消融組和傳統(tǒng)組,其中45例選擇甲狀腺微波消融術(shù),45例選擇甲狀腺傳統(tǒng)手術(shù),采用ELISA法對2組患者術(shù)后12h的白細胞介素(IL-6)、C反應(yīng)蛋白(CRP)及腫瘤壞死因子(TNF-a)這些創(chuàng)傷指標進行檢測和分析比較,采用電化學(xué)發(fā)光免疫法測定2組血清總?cè)饧紫僭彼?TT3)、血清總甲狀腺素(TT4)、血清游離三碘甲腺原氨酸(f T3)、血清游離甲狀腺素(f T4)、促甲狀腺激素(TSH)的含量變化,同時對術(shù)中出血量、手術(shù)時間、住院時間以及術(shù)后并發(fā)癥進行統(tǒng)計和比較。結(jié)果:(1)微波消融組術(shù)后12 h CRP(0.6±0.1)mg/L,明顯低于傳統(tǒng)手術(shù)組(11.9±2.1)mg/L(t=-35.934,P=0.000);IL-6(3.5±1.2)ng/L,明顯低于傳統(tǒng)手術(shù)組(14.3±4.4)ng/L(t=-15.885,P=0.000);TNF-a(43.1±6.1)ng/L,明顯低于傳統(tǒng)手術(shù)組(50.1±2.7)ng/L(t=-7.039,P=0.000)。(2)微波組術(shù)后TSH、T3、T4、f T3、f T4值分別為(nmol/L):3.16±0.98、2.43±0.68、96.50±22.88、16.68±2.16、16.68±2.16;傳統(tǒng)手術(shù)組為(nmol/L):3.31±0.79、2.72±0.74、96.80±23.47、16.61±2.35、16.61±2.35,兩組差異均無統(tǒng)計學(xué)意義P0.05。(3)微波消融組術(shù)中出血量(12.3±2.1)ml,明顯少于傳統(tǒng)手術(shù)組(29.2±4.1)ml(t=-24.610,P=0.000);手術(shù)時間(29.4±5.4)min明顯短于傳統(tǒng)手術(shù)組(82.2±14.8)ml(P=-22.482,t=0.000);住院時間(1.6±0.7)d明顯低于傳統(tǒng)手術(shù)組(4.2±0.4)d(t=-21.633,P=0.000)。2組術(shù)后并發(fā)癥發(fā)生率無顯著差異(微波消融組4例,傳統(tǒng)手術(shù)組6例,c2=0.450,P=0.502)。(4)微波消融組術(shù)后結(jié)節(jié)經(jīng)過1、3、6、12個月的隨訪,其結(jié)節(jié)縮小率平均分別為22.2%、52.3%、68.2%、88.8%。結(jié)論:超聲引導(dǎo)下微波消融治療甲狀腺良性結(jié)節(jié)較傳統(tǒng)手術(shù)對機體創(chuàng)傷較小,安全可靠,具有創(chuàng)傷小、美觀及術(shù)后恢復(fù)快等優(yōu)點,療效確切,值得臨床推廣。
[Abstract]:Objective: microwave ablation has become a new and important method in the treatment of benign thyroid nodules in recent years. Compared with traditional surgery, microwave ablation has the advantages of quick recovery, less trauma and beautiful incision. I have been accepted by more and more patients, but as a principle of thermal ablation for the treatment of benign thyroid nodules, there is still a certain degree of trauma to the body, the specific degree of trauma compared with the traditional surgery lack of clinical experimental research. Tumor necrosis factor (a(Tumor Necrosis) Factor-a (TNF-a), Interleukin6 (IL-6) and C-reactive protein (CRP) are commonly used to reflect the degree of trauma to the body, and thyroid hormone is also an important index to reflect the degree of trauma after thyroid injury. Therefore, we monitored two kinds of operation (microwave ablation and traditional resection) for benign thyroid nodules: serum TNF-aji-IL-6 CRP, total triiodothyronine TT3, serum total thyroxine TT4, serum free triiodothyronine before and after operation, and serum free triiodothyronine. The changes of serum free thyroxine fT4 and thyrotropin TSHs were observed. In order to explore the effect of two treatment methods on human body trauma. Methods: from October 2013 to June 2014, 90 patients with benign thyroid nodules who were diagnosed as benign thyroid nodules who were admitted to the Department of General surgery of the 81st Hospital of Nanjing PLA were selected. The patients were divided into microwave ablation group and traditional group voluntarily. Among them, 45 patients chose microwave ablation of thyroid gland and 45 patients chose traditional thyroid surgery. The ELISA method was used to detect and compare the levels of IL-6 C-reactive protein (CRP) and tumor necrosis factor TNF-a (TNF- 偽) in patients of both groups at 12 hours after operation. The changes of serum total triiodothyronine (TT-3), total thyroxine (T4), free triiodothyronine (FT3), serum free thyroxine (FT4) and thyrotropin (TSHs) were determined by electrochemiluminescence immunoassay (ECLIA). At the same time, the amount of intraoperative bleeding, operative time, hospital stay and postoperative complications were compared. 緇撴灉:(1)寰嘗娑堣瀺緇勬湳鍚，

本文編號：1984902