腔镜与开放手术在甲状腺近全切除术后引流量与全身创伤反应的对比

发布时间：2018-12-23 10:07

【摘要】：目的探讨在双侧甲状腺近全切除术中,腔镜手术(胸乳入路腔镜甲状腺手术)与开放手术(传统颈部切口甲状腺手术)在术后引流量、全身创伤反应方面的差异,为选择合适的手术方式提供依据。方法采用前瞻性临床对照研究,将80例初次行双侧甲状腺近全切除术的患者根据手术方式将其分为腔镜手术组(A组)和开放手术组(B组)各40例,分别统计术后引流液总量、术后拔管天数、术后每天引流量,术后第1天引流液甘油三酯(TG)、总蛋白(TP)含量,术前与术后第1天静脉血白细胞介素-6(IL-6)、超敏C反应蛋白(HS-CRP)、α1-酸性糖蛋白(AAG)、铜蓝蛋白(CER)、触珠蛋白(HPT)含量,对比分析两组间上述指标的差异及变化规律。结果 A组平均术后引流液总量比B组显著增多(P=0.000),平均术后拔管天数比B组显著延长(P=0.000);A组术后每天平均引流量同期均比B组多(P=0.000),二者每天引流量变化趋势均为逐渐下降。两组术后第1天引流液中甘油三酯、总蛋白含量比较均无显著差异性(P=0.429,P=0.324)。在A组或B组中,术后第1天静脉血中α1-酸性糖蛋白、铜蓝蛋白、触珠蛋白含量各自与术前比较均无显著差异性(P0.05);而术后第1天静脉血中白细胞介素-6、超敏C反应蛋白含量与术前比较均有显著差异性(P=0.000)。A组术后第1天血清白细胞介素-6、超敏C反应蛋白含量与B组比较均无显著差异性(P=0.054,P=0.066)。结论在双侧甲状腺近全切除手术中,与开放手术相比较,尽管腔镜手术术后引流量增多、拔管时间延长,但是并不增加全身的创伤反应程度。因此,对于有颈部无瘢痕美容要求的患者,腔镜手术可作为常规选择手术方式之一。
[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 伪 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 伪 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.
【作者单位】：南方医科大学珠江医院普通外科;
【分类号】：R653

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