本文選題：甲狀腺微小乳頭狀癌　切入點：腔鏡甲狀腺手術　出處：《皖南醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過對比分析腔鏡甲狀腺手術與傳統(tǒng)開放甲狀腺手術在治療甲狀腺微小乳頭狀癌的臨床應用相關指標的差異,探討腔鏡甲狀腺手術治療甲狀腺微小乳頭狀癌的安全性及可行性,分析其優(yōu)勢及,明確腔鏡甲狀腺手術在治療甲狀腺微小乳頭狀癌的臨床應用價值。方法:選擇2015年6月~2016年12月在皖南醫(yī)學院第一附屬醫(yī)院甲乳外科診斷甲狀腺微小乳頭狀癌的42例患者,分成兩組:觀察組(SET組)與對照組(TOT組),每組21例,SET組行腔鏡甲狀腺癌根治術,TOT組行傳統(tǒng)開放甲狀腺癌根治術,對比分析兩組術式在手術時間、手術出血量、術后拔管時間、術后并發(fā)癥數、炎癥因子(TNF-α、IL-17)、VAS評分(術后24小時)、清掃淋巴結數、術后沖洗液找腫瘤細胞、住院時間、住院費用情況,用SPSS 20.0統(tǒng)計軟件分別對其行卡方檢驗或t檢驗分析,探討其差異性。結果:所有手術均順利完成,SET組無中轉開放病例。兩組在術后拔管時間、清掃淋巴結數方面差異無統(tǒng)計學意義(P0.05),兩組均無術后出血、喉上神經、喉返神經損傷、甲狀旁腺損傷、氣管損傷等嚴重并發(fā)癥的發(fā)生。兩組術后并發(fā)癥數方面的差異無統(tǒng)計學意義(P0.05);SET組的手術時間明顯高于TOT組(P0.01),而手術出血量、VAS評分明顯低于TOT組(P0.01)。兩種手術方式相比,SET組術后第三天IL-17濃度低于術后第一天(P0.01);TOT組術后第三天IL-17濃度低于術后第一天(P0.01);手術方式對IL-17的濃度沒有顯著影響(F=0.039,P=0.844),SET組術后與TOT組術后IL-17濃度差異不具有統(tǒng)計學意義。SET組術后第三天TNF-α含量低于術后第一天(P0.01);TOT組術后第三天TNF-α含量低于術后第一天(P0.01);手術方式對TNF-α的濃度沒有顯著影響(F=0.593,P=0.446),SET組術后與TOT組術后TNF-α含量差異不具有統(tǒng)計學意義。SET組手術病人,手術后手術腔沖洗液均未發(fā)現腫瘤細胞。兩組患者住院時間差異無統(tǒng)計學意義(P0.05),而SET組的住院費用明顯高于TOT組(P0.01)。對兩組患者術后隨訪,進行甲狀腺功能及甲狀腺彩超檢查,目前未發(fā)現局部復發(fā)或淋巴結轉移情況。結論:對于PTMC患者,行腔鏡甲狀腺癌根治術可達到與傳統(tǒng)開放手術相同的手術范圍,美容效果好,出血量少,并發(fā)癥的發(fā)生幾率相似。腔鏡甲狀腺手術治療PTMC時對機體的應激狀態(tài)改變與開放手術相比差異無統(tǒng)計學意義。腔鏡甲狀腺手術治療PTMC是安全的手術方式,可完整清掃中央區(qū)淋巴結,可在臨床上推廣應用。
[Abstract]:Objective: to compare the clinical application of endoscopic thyroid surgery and traditional open thyroid surgery in the treatment of thyroid micropapillary carcinoma. To investigate the safety and feasibility of endoscopic thyroid surgery in the treatment of thyroid micropapillary carcinoma. To determine the clinical value of endoscopic thyroid surgery in the treatment of thyroid micropapillary carcinoma. Methods: from June 2015 to December 2016, 42 cases of thyroid micropapillary carcinoma were diagnosed by thyroid surgery in the first affiliated Hospital of Southern Anhui Medical College. Two groups were divided into two groups: observation group (set group) and control group (tot group). 21 patients in each group were treated with endoscopic radical thyroidectomy and tot group received traditional open radical thyroidectomy. The operative time, blood loss and extubation time were compared between the two groups. The number of postoperative complications, the inflammatory factor TNF- 偽 IL-17 / VAS score (24 hours after operation, the number of lymph nodes dissected, the amount of washing fluid after operation to find tumor cells, the length of stay, and the cost of hospitalization were analyzed by chi-square test or t-test with SPSS 20.0 statistical software). Results: all the operations were completed successfully in the set group. There were no cases in the two groups. There was no significant difference in the extubation time and the number of lymph nodes dissected between the two groups (P 0.05). There was no postoperative hemorrhage, injury of the superior laryngeal nerve and recurrent laryngeal nerve in the two groups. Parathyroid injury, There was no significant difference in the number of postoperative complications between the two groups. The operative time in the set group was significantly higher than that in the TOT group, and the VAS score was significantly lower than that in the TOT group. The IL-17 concentration on the third day after operation in the set group was lower than that on the third day after operation in the P0.01TOT group, and the IL-17 concentration on the third day after operation was lower than that on the first day after operation, and there was no significant difference in the concentration of IL-17 between the two groups. There was no statistical difference between the postoperative IL-17 concentration of the two groups and that of the TOT group. The content of TNF- 偽 in the set group on the third day after operation was lower than that in the first day after operation, and the level of TNF- 偽 in the set group on the third day after operation was lower than that in the first day after operation, and the level of TNF- 偽 was not significantly affected by the operation method. There was no significant difference in the content of TNF- 偽 between the TOT group and the group of TOT on the third day after operation. Statistical significance. Set group of surgical patients, No tumor cells were found in the flushing fluid of the operation cavity after operation. There was no significant difference in the hospitalization time between the two groups, but the hospitalization cost in the SET group was significantly higher than that in the TOT group (P 0.01). No local recurrence or lymph node metastasis was found at present. Conclusion: for PTMC patients, endoscopic radical thyroidectomy can achieve the same surgical scope as traditional open surgery, with good cosmetic effect and less bleeding. The incidence of complications was similar. There was no significant difference in stress state between endoscopic thyroidectomy and open surgery in the treatment of PTMC. Endoscopic thyroidectomy was a safe surgical method for the treatment of PTMC. The central lymph nodes can be completely dissected and can be popularized and applied in clinic.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R736.1

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