微波消融术与传统开放式手术在良性甲状腺结节治疗中对机体创伤影响的比较

发布时间：2018-06-06 03:40

  本文选题：微波消融 + 甲状腺切除术　； 参考：《安徽医科大学》2016年硕士论文

【摘要】：目的:近年来微波消融术已经成为治疗甲状腺良性结节新的重要方法,相对于传统手术,微波消融术具有恢复快、创伤小、切口美观等优点,作为一种微创的治疗方法,越来越我被广大患者所接受,但是作为热消融原理治疗甲状腺良性结节,其对机体仍然存在一定创伤,具体创伤程度与传统手术相比缺乏临床实验研究。肿瘤坏死因子a(Tumor Necrosis Factor-a,TNF-a)、白介素6(Interleukin6,IL-6)、C反应蛋白(C-reactive protein,CRP)是反映手术对机体创伤程度的常用指标,同时甲状腺激素也是反映甲状腺创伤后的重要指标,因此我们监测了良性甲状腺结节患者两种手术(微波消融术和传统切除术)术前术后血清TNF-a、IL-6、CRP、血清总三碘甲腺原氨酸(TT3)、血清总甲状腺素(TT4)、血清游离三碘甲腺原氨酸(f T3)、血清游离甲状腺素(f T4)、促甲状腺激素(TSH)的含量变化,并进行对比,以探讨两种治疗方法对人体创伤的影响。方法:选择2013年10月至2014年6月期间,南京解放军第八一医院普外科收治的90例诊断为良性甲状腺结节需要手术治疗,未服用任何药物的患者,根据患者自愿分为微波消融组和传统组,其中45例选择甲状腺微波消融术,45例选择甲状腺传统手术,采用ELISA法对2组患者术后12h的白细胞介素(IL-6)、C反应蛋白(CRP)及肿瘤坏死因子(TNF-a)这些创伤指标进行检测和分析比较,采用电化学发光免疫法测定2组血清总三碘甲腺原氨酸(TT3)、血清总甲状腺素(TT4)、血清游离三碘甲腺原氨酸(f T3)、血清游离甲状腺素(f T4)、促甲状腺激素(TSH)的含量变化,同时对术中出血量、手术时间、住院时间以及术后并发症进行统计和比较。结果:(1)微波消融组术后12 h CRP(0.6±0.1)mg/L,明显低于传统手术组(11.9±2.1)mg/L(t=-35.934,P=0.000);IL-6(3.5±1.2)ng/L,明显低于传统手术组(14.3±4.4)ng/L(t=-15.885,P=0.000);TNF-a(43.1±6.1)ng/L,明显低于传统手术组(50.1±2.7)ng/L(t=-7.039,P=0.000)。(2)微波组术后TSH、T3、T4、f T3、f T4值分别为(nmol/L):3.16±0.98、2.43±0.68、96.50±22.88、16.68±2.16、16.68±2.16;传统手术组为(nmol/L):3.31±0.79、2.72±0.74、96.80±23.47、16.61±2.35、16.61±2.35,两组差异均无统计学意义P0.05。(3)微波消融组术中出血量(12.3±2.1)ml,明显少于传统手术组(29.2±4.1)ml(t=-24.610,P=0.000);手术时间(29.4±5.4)min明显短于传统手术组(82.2±14.8)ml(P=-22.482,t=0.000);住院时间(1.6±0.7)d明显低于传统手术组(4.2±0.4)d(t=-21.633,P=0.000)。2组术后并发症发生率无显著差异(微波消融组4例,传统手术组6例,c2=0.450,P=0.502)。(4)微波消融组术后结节经过1、3、6、12个月的随访,其结节缩小率平均分别为22.2%、52.3%、68.2%、88.8%。结论:超声引导下微波消融治疗甲状腺良性结节较传统手术对机体创伤较小,安全可靠,具有创伤小、美观及术后恢复快等优点,疗效确切,值得临床推广。
[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- 伪) 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. 缁撴灉:(1)寰�娉㈡秷铻嶇粍鏈�鍚，

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