腔镜甲状腺手术治疗甲状腺微小乳头状癌的临床应用

发布时间：2018-03-17 07:14

本文选题：甲状腺微小乳头状癌　切入点：腔镜甲状腺手术　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对比分析腔镜甲状腺手术与传统开放甲状腺手术在治疗甲状腺微小乳头状癌的临床应用相关指标的差异,探讨腔镜甲状腺手术治疗甲状腺微小乳头状癌的安全性及可行性,分析其优势及,明确腔镜甲状腺手术在治疗甲状腺微小乳头状癌的临床应用价值。方法:选择2015年6月~2016年12月在皖南医学院第一附属医院甲乳外科诊断甲状腺微小乳头状癌的42例患者,分成两组:观察组(SET组)与对照组(TOT组),每组21例,SET组行腔镜甲状腺癌根治术,TOT组行传统开放甲状腺癌根治术,对比分析两组术式在手术时间、手术出血量、术后拔管时间、术后并发症数、炎症因子(TNF-α、IL-17)、VAS评分(术后24小时)、清扫淋巴结数、术后冲洗液找肿瘤细胞、住院时间、住院费用情况,用SPSS 20.0统计软件分别对其行卡方检验或t检验分析,探讨其差异性。结果:所有手术均顺利完成,SET组无中转开放病例。两组在术后拔管时间、清扫淋巴结数方面差异无统计学意义(P0.05),两组均无术后出血、喉上神经、喉返神经损伤、甲状旁腺损伤、气管损伤等严重并发症的发生。两组术后并发症数方面的差异无统计学意义(P0.05);SET组的手术时间明显高于TOT组(P0.01),而手术出血量、VAS评分明显低于TOT组(P0.01)。两种手术方式相比,SET组术后第三天IL-17浓度低于术后第一天(P0.01);TOT组术后第三天IL-17浓度低于术后第一天(P0.01);手术方式对IL-17的浓度没有显著影响(F=0.039,P=0.844),SET组术后与TOT组术后IL-17浓度差异不具有统计学意义。SET组术后第三天TNF-α含量低于术后第一天(P0.01);TOT组术后第三天TNF-α含量低于术后第一天(P0.01);手术方式对TNF-α的浓度没有显著影响(F=0.593,P=0.446),SET组术后与TOT组术后TNF-α含量差异不具有统计学意义。SET组手术病人,手术后手术腔冲洗液均未发现肿瘤细胞。两组患者住院时间差异无统计学意义(P0.05),而SET组的住院费用明显高于TOT组(P0.01)。对两组患者术后随访,进行甲状腺功能及甲状腺彩超检查,目前未发现局部复发或淋巴结转移情况。结论:对于PTMC患者,行腔镜甲状腺癌根治术可达到与传统开放手术相同的手术范围,美容效果好,出血量少,并发症的发生几率相似。腔镜甲状腺手术治疗PTMC时对机体的应激状态改变与开放手术相比差异无统计学意义。腔镜甲状腺手术治疗PTMC是安全的手术方式,可完整清扫中央区淋巴结,可在临床上推广应用。
[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- 伪 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- 伪 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- 伪 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- 伪 was not significantly affected by the operation method. There was no significant difference in the content of TNF- 伪 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.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1

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