小切口腔镜甲状腺切除术治疗分化型甲状腺癌的效果及对免疫抑制和肿瘤指标的影响

Effect of small incision endoscopic thyroidectomy on differentiated thyroid cancer and its effect on immunosuppression and tumor indexes

目的探讨小切口腔镜甲状腺切除术治疗分化型甲状腺癌(DTC)的临床效果。方法选取安徽皖北医院2019年7月至2020年7月收治的63例DTC患者,按手术方案分为两组,33例行完全腔镜甲状腺切除术为对照组,30例行小切口腔镜甲状腺切除术为试验组。比较两组手术及术后恢复情况,术前、术后第1、3天免疫抑制指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平,术前、术后1个月肿瘤指标[血管内皮生长因子(VEGF)、甲状腺球蛋白(Tg)]水平和并发症发生情况。结果试验组手术时间短于对照组[(87.73±15.35)min比(102.45±20.78)min,t=3.171,P=0.002],术中出血量少于对照组[(20.37±5.26)ml比(44.25±6.39)ml,t=16.099,P<0.001],切口长度、术后住院时间短于对照组[(2.03±0.14)cm比(2.58±0.18)cm,t=13.440,P<0.001;(4.58±1.17)d比(6.02±1.09)d,t=5.057,P<0.001],淋巴结清扫数目多于对照组[(6.20±1.08)个比(5.12±1.13)个,t=3.869,P<0.001],差异均有统计学意义。与术前比较,术后第1天两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平降低,CD8^(+)水平升高,但试验组变化幅度较小,且试验组术后第3天即恢复至术前水平(P>0.05)。两组术后1个月血清VEGF、Tg低于术前(P<0.05),但组间比较差异无统计学意义(P>0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论小切口腔镜甲状腺切除术治疗DTC可达到与完全腔镜甲状腺切除术相同的肿瘤治疗效果,且显著缩短手术时间,减少创伤及术中出血,减轻免疫抑制,有利于患者术后康复。

Objective To explore the clinical effect of small incision endoscopic thyroidectomy in the treatment of differentiated thyroid cancer(DTC).Method The clinical data of 63 patients with DTC in Anhui Wanbei Hospital were analyzed retrospectively.According to different surgical schemes,33 patients who underwent complete endoscopic thyroidectomy were listed as the control group and 30 patients who underwent small oral endoscopic thyroidectomy were listed as the experimental group.The operation and postoperative recovery,immunosuppressive indexes(CD_(3)^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))before operation and on the first and third day after operation,the levels of tumor indexes vascular endothelial growth factor(VEGF),thyroglobulin(Tg)before operation and one month after operation and the incidence of complications were compared between the two groups.Results Compared with the control group,the operation time in the experimental group was shorter:(87.73±15.35)min vs.(102.45±20.78)min,t=3.171,P=0.002;the amount of intraoperative bleeding in the experimental group was shorter:(20.37±5.26)ml vs.(44.25±6.39)ml,t=16.099,P<0.001;the incision length and the postoperative hospital stay in the experimental group were lower:(2.03±0.14)cm vs.(2.58±0.18)cm,t=13.440,P<0.001;(4.58±1.17)d vs.(6.02±1.09)d,t=5.057,P<0.001;the number of lymph node dissections in the experimental group was more:(6.20±1.08)cases vs.(5.12±1.13)cases,t=3.869,P<0.001.Compared with before operation,the levels of CD_(3)^(+),CD4^(+),CD4^(+)/CD8^(+)decreased and CD8^(+)increased in the two groups on the first day after operation,but the change range in the experimental group was small,and the experimental group recovered to the preoperative level on the third day after operation(P>0.05).One month after operation,the levels of serum VEGF and Tg in the two groups were lower than those before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions Small incision endoscopic thyroidectomy in the treatment of DTC can achieve the same tumor treatment effect as complete endoscopic surgery,significantly shorten the operation time,reduce incision trauma and intraoperative bleeding,and reduce immunosuppression,which is conducive to postoperative rehabilitation and good treatment safety.