發(fā)布時間：2018-12-23 10:07

【摘要】：目的探討在雙側(cè)甲狀腺近全切除術(shù)中,腔鏡手術(shù)(胸乳入路腔鏡甲狀腺手術(shù))與開放手術(shù)(傳統(tǒng)頸部切口甲狀腺手術(shù))在術(shù)后引流量、全身創(chuàng)傷反應(yīng)方面的差異,為選擇合適的手術(shù)方式提供依據(jù)。方法采用前瞻性臨床對照研究,將80例初次行雙側(cè)甲狀腺近全切除術(shù)的患者根據(jù)手術(shù)方式將其分為腔鏡手術(shù)組(A組)和開放手術(shù)組(B組)各40例,分別統(tǒng)計術(shù)后引流液總量、術(shù)后拔管天數(shù)、術(shù)后每天引流量,術(shù)后第1天引流液甘油三酯(TG)、總蛋白(TP)含量,術(shù)前與術(shù)后第1天靜脈血白細(xì)胞介素-6(IL-6)、超敏C反應(yīng)蛋白(HS-CRP)、α1-酸性糖蛋白(AAG)、銅藍(lán)蛋白(CER)、觸珠蛋白(HPT)含量,對比分析兩組間上述指標(biāo)的差異及變化規(guī)律。結(jié)果 A組平均術(shù)后引流液總量比B組顯著增多(P=0.000),平均術(shù)后拔管天數(shù)比B組顯著延長(P=0.000);A組術(shù)后每天平均引流量同期均比B組多(P=0.000),二者每天引流量變化趨勢均為逐漸下降。兩組術(shù)后第1天引流液中甘油三酯、總蛋白含量比較均無顯著差異性(P=0.429,P=0.324)。在A組或B組中,術(shù)后第1天靜脈血中α1-酸性糖蛋白、銅藍(lán)蛋白、觸珠蛋白含量各自與術(shù)前比較均無顯著差異性(P0.05);而術(shù)后第1天靜脈血中白細(xì)胞介素-6、超敏C反應(yīng)蛋白含量與術(shù)前比較均有顯著差異性(P=0.000)。A組術(shù)后第1天血清白細(xì)胞介素-6、超敏C反應(yīng)蛋白含量與B組比較均無顯著差異性(P=0.054,P=0.066)。結(jié)論在雙側(cè)甲狀腺近全切除手術(shù)中,與開放手術(shù)相比較,盡管腔鏡手術(shù)術(shù)后引流量增多、拔管時間延長,但是并不增加全身的創(chuàng)傷反應(yīng)程度。因此,對于有頸部無瘢痕美容要求的患者,腔鏡手術(shù)可作為常規(guī)選擇手術(shù)方式之一。
[Abstract]:Objective to investigate the difference between endoscopic thyroidectomy (endoscopic thyroidectomy) and open surgery (traditional cervical incision thyroidectomy) in bilateral proximal thyroidectomy. To provide a basis for the selection of appropriate surgical methods. Methods A prospective clinical controlled study was carried out in 80 patients undergoing bilateral proximal thyroidectomy for the first time. According to the operative methods, 80 patients were divided into two groups: endoscopic group (group A) and open operation group (group B). The total amount of drainage fluid, the days of extubation, the daily drainage volume, the content of triglyceride (TG), total protein (TP) on the first day after operation, and the level of interleukin-6 (IL-6) in venous blood before and after operation were counted respectively. The content of (HPT) in (CER), of hypersensitive C-reactive protein (HS-CRP) and 偽 1-acidic glycoprotein (AAG), ceruloplasmin, was compared and analyzed between the two groups. Results the total amount of drainage in group A was significantly higher than that in group B (P0. 000), and the average days of extubation was significantly longer than that in group B (P0. 000). The average daily drainage volume in group A was higher than that in group B (P < 0. 000). There was no significant difference in triglyceride and total protein content between the two groups on the first day after operation (P < 0. 429, P < 0. 324). In group A or group B, the contents of 偽 1-acidic glycoprotein, ceruloplasmin and thioglobin in venous blood on the first day after operation were not significantly different from those before operation (P0.05). On the first day after operation, the levels of interleukin-6 and hypersensitive C-reactive protein in venous blood were significantly different from those before operation (P < 0. 000). A). There was no significant difference between group B and group B in the content of hypersensitive C-reactive protein (P0. 054, P0. 066). Conclusion in bilateral proximal thyroidectomy, compared with open surgery, although the drainage volume increased and the extubation time prolonged after endoscopic surgery, it did not increase the degree of traumatic reaction of the whole body. Therefore, endoscopic surgery can be used as a routine choice for patients with scar-free neck.
【作者單位】： 南方醫(yī)科大學(xué)珠江醫(yī)院普通外科;
【分類號】：R653

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