【摘要】：目的:目前,治療甲狀腺癌的手術(shù)方式有傳統(tǒng)開(kāi)放及腔鏡兩種,腔鏡又分為二維及三維系統(tǒng)。三維腔鏡應(yīng)用于外科手術(shù)療效受到廣泛認(rèn)可,然而,其應(yīng)用于甲狀腺癌手術(shù)的臨床研究卻甚少,未能充分體現(xiàn)3D腔鏡在治療甲狀腺癌上的優(yōu)勢(shì)。本文通過(guò)對(duì)比3D腔鏡、2D腔鏡及開(kāi)放手術(shù)三種方式治療分化型甲狀腺癌的臨床實(shí)際療效及其對(duì)機(jī)體炎癥反應(yīng)的影響,來(lái)探討3D腹腔鏡在甲狀腺全切聯(lián)合中央?yún)^(qū)淋巴結(jié)清掃術(shù)中的應(yīng)用價(jià)值。方法:通過(guò)回顧性分析于2013年09月至2016年04月在南方醫(yī)科大學(xué)珠江醫(yī)院普通外科就診的90例分化型甲狀腺癌患者的臨床資料,根據(jù)手術(shù)方式不同分為3D腔鏡組、2D腔鏡組及開(kāi)放組三組,每組病例數(shù)均為30例,入圍病例均經(jīng)術(shù)后石蠟病理結(jié)果確診為分化型甲狀腺癌。腔鏡組均采用經(jīng)胸乳入路手術(shù)方案,開(kāi)放手術(shù)組采用頸部低衣領(lǐng)式切口。比較三組患者手術(shù)時(shí)間、術(shù)中出血量、術(shù)后頸部引流管引流量、術(shù)后住院天數(shù)、術(shù)后病理提示淋巴結(jié)個(gè)數(shù)及淋巴結(jié)轉(zhuǎn)移個(gè)數(shù)、住院費(fèi)用等臨床指標(biāo),術(shù)后不良反應(yīng)及炎癥指標(biāo)等,應(yīng)用統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行處理分析,并得出結(jié)論。結(jié)果:通過(guò)統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行分析處理后顯示,與開(kāi)放組、2D腔鏡組相比,3D腔鏡組術(shù)中出血量更少,3D腔鏡組與開(kāi)放組相比術(shù)后不良反應(yīng)發(fā)生率低,其中以術(shù)后頭暈嘔吐等不適反應(yīng)發(fā)生率低為主,且3D腔鏡組無(wú)一例患者術(shù)后出現(xiàn)聲音嘶啞、飲水嗆咳等甲狀腺手術(shù)主要并發(fā)癥。3D腔鏡組相對(duì)于2D腔鏡組手術(shù)時(shí)間縮短(P0.05),平均縮短約22min。腔鏡組間總住院費(fèi)用無(wú)明顯差異,2D住院總費(fèi)用約18050±129元,3D組住院總費(fèi)用約19675±1147元,3D腔鏡組與傳統(tǒng)2D腔鏡組相比并不會(huì)增加患者的住院費(fèi)用。3D組與其他兩組相比術(shù)后引流量差異無(wú)統(tǒng)計(jì)學(xué)意義。三者間術(shù)后住院時(shí)間、淋巴結(jié)清掃個(gè)數(shù)、中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移個(gè)數(shù)以及手術(shù)對(duì)機(jī)體炎癥反應(yīng)的影響等差異不具統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:3D腔鏡技術(shù)行甲狀腺全切聯(lián)合中央?yún)^(qū)淋巴結(jié)清掃術(shù)是安全、有效的,與傳統(tǒng)2D腔鏡及開(kāi)放手術(shù)相比,可明顯減少術(shù)中出血量,且與2D腔鏡相比手術(shù)時(shí)間大大減少的同時(shí)并不會(huì)增加患者額外經(jīng)濟(jì)負(fù)擔(dān)。與開(kāi)放手術(shù)相比,3D腔鏡可明顯降低圍手術(shù)期不良反應(yīng)發(fā)生率。傳統(tǒng)觀念認(rèn)為,腔鏡甲狀腺手術(shù)因其需建立皮下隧道而增加對(duì)機(jī)體的創(chuàng)傷。本研究表明:腔鏡組與開(kāi)放組之間炎癥指標(biāo)差異無(wú)統(tǒng)計(jì)學(xué)意義,提示腔鏡手術(shù)并不會(huì)增加對(duì)患者的創(chuàng)傷影響。因此,3D腔鏡手術(shù)具有術(shù)中出血量少、可減少術(shù)后不良反應(yīng)發(fā)生率、美容效果好、對(duì)機(jī)體創(chuàng)傷影響小等特點(diǎn),可作為分化型甲狀腺癌手術(shù)的重要選擇方式。
[Abstract]:Objective: at present, there are two kinds of operative methods for thyroid carcinoma: traditional open and endoscopy, which can be divided into two-dimensional and three-dimensional systems. The effect of 3D endoscopy in surgical treatment is widely accepted, however, there are few clinical studies on its application in thyroid cancer surgery, which fails to fully reflect the advantages of 3D endoscopy in the treatment of thyroid carcinoma. In this paper, we compared the clinical effect of 3D endoscopy, 2D endoscopy and open operation on differentiated thyroid carcinoma and its effect on inflammatory reaction. To evaluate the value of 3 D laparoscopy in total thyroidectomy combined with central lymph node dissection. Methods: the clinical data of 90 patients with differentiated thyroid carcinoma from September 2013 to April 2016 in Zhujiang Hospital of Southern Medical University were retrospectively analyzed. There were 30 cases in each group in 2D endoscopic group and open group. All cases were confirmed as differentiated thyroid carcinoma by paraffin wax pathological results after operation. The endoscopic group was treated by transthoracic approach, and the open group was treated with low collar neck incision. The time of operation, the amount of blood lost during operation, the drainage flow of cervical drainage tube, the days of hospitalization, the number of lymph nodes, the number of lymph node metastasis, the cost of hospitalization were compared among the three groups. The adverse reaction and inflammation index were analyzed by statistical software, and the conclusion was drawn. Results: the data were analyzed and processed by statistical software. Compared with the open group and 2D group, the volume of intraoperative bleeding was less in the 3D endoscopic group, and the incidence of postoperative adverse reactions was lower in the 3D endoscopic group than in the open group. Among them, the incidence of postoperative discomfort such as dizziness and vomiting was low, and none of the patients in the 3D endoscopic group had hoarseness after operation. The operative time of 3D endoscopic group was shorter than that of 2D endoscopic group (P0.05), and the average shortening was about 22 mins. There was no significant difference in total hospitalization cost between endoscopic group and 3D group. The total cost of 2D hospitalization was 18050 鹵129.The total cost of 3D group was about 19675 鹵1147 yuan. The cost of hospitalization was not increased in 3D group compared with the traditional 2D group. There was no significant difference in postoperative drainage between 3D group and other two groups. There were no significant differences among the three groups in the length of hospitalization, the number of lymph nodes dissection, the number of lymph node metastasis in the central area and the effect of operation on the inflammatory response of the body (P0.05). Conclusion: total thyroidectomy combined with central lymph node dissection is safe and effective. Compared with traditional 2D endoscopy and open surgery, the amount of intraoperative bleeding can be significantly reduced. And compared with 2 D endoscopy, the operation time is greatly reduced, and does not increase the additional economic burden of patients. Compared with open surgery, 3D endoscopy can significantly reduce the incidence of perioperative adverse reactions. Traditionally, endoscopic thyroid surgery has increased the trauma due to the need to build subcutaneous tunnels. This study showed that there was no significant difference in inflammatory markers between the endoscopic group and the open group, suggesting that endoscopic surgery did not increase the traumatic impact on patients. Therefore, 3D endoscopic surgery has the characteristics of less intraoperative bleeding, less postoperative adverse reactions, better cosmetic effect and less impact on body trauma. It can be used as an important choice for differentiated thyroid carcinoma surgery.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R736.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 嵇武;;三維立體(3D)腹腔鏡的研究與應(yīng)用進(jìn)展[J];中國(guó)微創(chuàng)外科雜志;2016年06期

2 董效東;侯占富;王立坤;武雪亮;;腔鏡甲狀腺部分切除術(shù)對(duì)患者機(jī)體炎性及免疫指標(biāo)的影響[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2016年09期

3 蘭霞斌;張浩;;《2015美國(guó)甲狀腺學(xué)會(huì)成人甲狀腺結(jié)節(jié)與分化型甲狀腺癌診治指南》外科治療更新解讀[J];浙江醫(yī)學(xué);2016年05期

4 段云飛;陳學(xué)敏;蔡輝華;孫冬林;;腔鏡甲狀腺全切除及中央?yún)^(qū)淋巴結(jié)清掃治療早期甲狀腺乳頭狀癌的臨床研究[J];中華內(nèi)分泌外科雜志;2016年01期

5 鄭民華;馬君俊;;3D腹腔鏡手術(shù)技術(shù)專(zhuān)家共識(shí)(2015)[J];中國(guó)實(shí)用外科雜志;2015年09期

6 周斌;單海琳;蘇瑛;鄒潤(rùn)龍;邵清;;納米炭在甲狀腺全切除聯(lián)合中央?yún)^(qū)淋巴結(jié)清掃中的應(yīng)用價(jià)值[J];中華內(nèi)分泌外科雜志;2015年04期

7 李艷;郭雄波;;腔鏡甲狀腺手術(shù)入路的發(fā)展和問(wèn)題思考[J];重慶醫(yī)學(xué);2015年23期

8 陳飛;郭雄波;;自制拉鉤在腔鏡甲狀腺手術(shù)中的應(yīng)用[J];國(guó)際外科學(xué)雜志;2015年08期

9 王勇;趙群仔;燕海潮;謝秋萍;李志宇;王平;徐少明;;三維腔鏡胸前入路甲狀腺癌手術(shù)32例臨床分析[J];中華外科雜志;2015年03期

10 鄒兆偉;黃宗海;李強(qiáng);陳飛;趙大川;汪勉;;3D腹腔鏡在經(jīng)胸乳入路甲狀腺次全切除術(shù)中的臨床效果[J];南方醫(yī)科大學(xué)學(xué)報(bào);2014年08期

，

本文編號(hào)：2412714