不同手术方法治疗甲状腺癌的疗效及其对患者炎症应激反应的影响

Curative effect of different surgical methods on thyroid cancer and their influences on inflammatory stress reactions

目的比较3D腔镜、2D腔镜和开放手术治疗甲状腺癌的效果,并探讨其对患者炎症应激反应的影响。方法选择2017年5月至2019年5月于西安国际医学中心医院就诊的甲状腺癌患者96例,按随机数表法分为3D腔镜组、2D腔镜组和开放手术组各32例,分别行3D腔镜手术、2D腔镜手术和开放手术。三组患者术后均随访3个月。比较三组患者的围术期相关指标、淋巴结清扫数、淋巴结阳性数、对切口美容满意度和不良反应发生率,同时比较三组患者手术前、手术后1 d的血清白细胞介素-6(IL-6)、C反应蛋白(CRP)及白细胞(WBC)水平。结果3D腔镜组患者术中出血量、住院时间分别为(41.33±4.13)mL、(5.25±0.53)d,明显少于2D腔镜组的(61.57±6.16)mL、(5.64±0.56)d及开放手术组的(89.02±8.90)mL、(6.03±0.60)d,差异均有统计学意义(P<0.05);2D腔镜组患者的手术时间为(146.48±14.65)min,明显长于3D腔镜组的(120.35±12.04)min和开放手术(100.17±10.02)min,差异均有统计学意义(P<0.05);2D腔镜组患者的引流量为(170.21±17.02)mL,明显多于3D腔镜组的(131.48±13.15)mL及开放手术组的(108.94±10.89)mL,差异均有统计学意义(P<0.05);三组患者的淋巴结清扫数及淋巴结阳性数比较差异均无统计学意义(P>0.05);开放手术组患者术后1 d的IL-6、CRP、WBC水平分别为(3.13±0.31)pg/mL、(4.79±0.48)g/mL、(10.17±1.02)×109/L,明显高于3D腔镜组的(2.65±0.27)pg/mL、(3.44±0.34)g/mL、(9.33±0.93)×109/L及2D腔镜组的(2.77±0.28)pg/mL、(3.55±0.36)g/mL、(9.54±0.95)×109/L,差异均有统计学意义(P<0.05),但3D腔镜组和2D腔镜组患者的IL-6、CRP、WBC比较差异均无统计学意义(P>0.05);3D腔镜组和2D腔镜组患者的切口美容满意度分别为84.38%、81.25%,明显高于开放手术组的56.25%,差异有统计学意义(P<0.05);三组患者术后不良反应发生率比较差异无统计学意义(P>0.05)。结论3D腔镜、2D腔镜和开放手术治疗甲状腺癌疗效无明显差异,腔镜手术引起炎症应激反应显著低于开放手术,3D腔镜组术中出血量和住院时间更短,但手术时间长于2D腔镜组,临床可根据患者实际情况进行选择。

Objective To compare the curative effect of 3D endoscopy,2D endoscopy and open surgery on thyroid cancer,and explore their influences on inflammatory stress reactions.Methods A total of 96 patients with thyroid cancer who were treated in Xi'an International Medical Center Hospital from May 2017 to May 2019 were enrolled.They were divided into 3D endoscopy group,2D endoscopy group and open surgery group by random number table method,with 32 patients in each group.The three groups underwent 3D endoscopy,2D endoscopy and open surgery,respectively.All patients in the three groups were followed up for 3 months after surgery.Perioperative related indexes,number of lymph node dissection,number of positive lymph nodes,satisfaction with incision cosmetology and incidence of adverse reactions were compared among the three groups.The levels of serum interleukin-6(IL-6),C-reactive protein(CRP),and white blood cells(WBC)before surgery and at 1 d after surgery were compared among the three groups.Results The intraoperative blood loss and hospitalization time in 3D endoscopy group were(41.33±4.13)mL and(5.25±0.53)d,which were significantly lower than corresponding(61.57±6.16)mL and(5.64±0.56)d in 2D endoscopy group,(89.02±8.90)mL and(6.03±0.60)d)in open surgery group(all P<0.05).The operation time in 2D endoscopy group was(146.48±14.65)min,which was significantly longer than corresponding(120.35±12.04)min in 3D endoscopy group and(100.17±10.02)min in open surgery group(P<0.05).The drainage volume in 2D endoscopy group was(170.21±17.02)mL,which was significantly more than corresponding(131.48±13.15)mL in 3D endoscopy group and(108.94±10.89)mL in open surgery group(P<0.05).There were no significant differences in dissection number and positive number of lymph nodes among the three groups(P>0.05).At 1 d after surgery,levels of IL-6,CRP and WBC in open surgery group were(3.13±0.31)pg/mL,(4.79±0.48)g/mL,(10.17±1.02)×109/L,respectively,which were significantly higher than corresponding(2.65±0.27)pg/mL,(3.44±0.34)g/mL,(9.33±0.93)×109/L,(2.77±0.28)pg/mL in 3D endoscopy group and corresponding(3.55±0.36)g/mL,(9.54±0.95)×109/L in 2D endoscopy group(all P<0.05).There were no significant differences in IL-6,CRP and WBC between 3D and 2D endoscopy groups(P>0.05).The satisfaction with incision cosmetology in 3D and 2D endoscopy groups was 84.38%and 81.25%,which was significantly higher than 56.25%in open surgery group(P<0.05).There was no significant difference in incidence of postoperative adverse reactions among the three groups(P>0.05).Conclusion There is no significant difference in the curative effect of 3D endoscopy,2D endoscopy and open surgery on thyroid cancer.The inflammatory stress reactions caused by endoscopy are significantly fewer than those caused by open surgery.The intraoperative blood loss and hospitalization time are fewer in the 3D endoscopy group,but the operative time is longer in the 2D endoscopy group.The clinical selection could be made according to the actual situation of the patients.