经胸壁入路内镜甲状腺切除术与开放甲状腺切除术围手术期创伤因素的对比研究

A comparative study for perioperative trauma of transthoracic endoscopic thyroidectomy and conventional thyroidectomy

目的:对胸壁入路内镜甲状腺切除术(transthoracic endoscopic thyroidectomy,TET)与传统开放甲状腺切除术(conventional thyroidectomy,CT)的创伤因素进行对比研究,探讨TET技术围手术期的创伤程度。方法:为40例甲状腺结节患者分别行TET及CT,每组各20例。分别检测两组患者术前及术后第1、3天血清中CRP、IL-6、TNF-α、T-淋巴细胞亚群(CD3+,CD4+,CD4+/CD8+)水平;比较两组手术时间、术中出血量、引流量、术后住院时间、并发症;视觉模拟评分法评估术后疼痛感受,5级评价法评估术后美容满意度。结果:TET组无中转常规手术,两组均未发生永久性喉返神经麻痹等严重并发症。两组CRP水平术后24、72h较术前明显升高(P<0.01),但组间差异无统计学意义(P>0.05)。IL-6、TNF-α、T-淋巴细胞亚群水平手术前后及组间比较差异均无统计学意义(P>0.05)。美容满意度TET组明显优于CT组(P<0.001)。两组疼痛反应、手术时间、术中出血量、引流量、术后住院时间差异均无统计学意义(P>0.05)。结论:TET与传统甲状腺手术相比,手术效果相当,但切口隐蔽,美容效果突出;本研究未发现经胸壁入路甲状腺切除术比传统手术有更严重的创伤反应,其生理和心理创伤总和小于传统手术。

Objective：To comparatively study the traumatic factors of transthoracic endoscopic thyroidectomy （TET） with conventional thyroidectomy （CT）, and investigate the perioperative trauma degree of TET. Methods：Forty patients with thyroid nodule were divided into two groups to perform TET and CT respectively. We examined the plasma levels of C-reactive protein （ CRP）, interleu- kin-6 （ IL-6）, tumor necrosis factor-alpha （ TNF-α ）, T-lymphocyte subsets （ CD3 ＋ , CD4 ＋ , CD4 ＋/CD8 ＋ ） preoperatively, on the first and third day after operation. Operative time, blood loss, the volume of drainage, postoperative hospital stay and complications of TET group were compared with those of CT group. Postoperative pain was evaluated by visual analogue scale （VAS） and cosmetic results were evaluated according to a 5 levels judgment. Results ： No case in TET group was convered to the traditional approach and no serious complications such as permanent recurrent laryngeal nerve paralysis happened in the two groups. Except the level of CRP, which in- creased significantly after operation at 24h and 72h （ P 〈 0. 01 ） , the postoperative level of IL-6, TNF-α, T-lymphocyte subsets （ CD3 ＋ , CD4 ＋ , CD4 ＋/CD8 ＋ ） did not change significantly compared with preoperative index （ P 〉 0.05 ）. There was no significant difference between two groups for each parameter （ CRP, IL-6,TNF-α,T-lymphocyte subsets） （P 〉 0. 05 ）. The cosmetic result in TET group was improved obviously than that in CT group （P 〈 0. 001 ）. There were no significant differences in pain, operative time, blood loss, the vol- ume of drainage and postoperative hospital stay between two groups （ P 〉 0.05 ）. Conclusions ： There is no evidence of more serious trauma in TET than in CT according to this study. With hidden incision, obviously cosmetic result and similar operative effect,the sum of psychological and physiological trauma in TET is less than that in CT.