腔镜甲状腺部分切除术对患者机体炎性及免疫指标的影响

Influence of endoscopic partial thyroidectomy on the inflammatory and immune indexes in patients

目的观察腔镜甲状腺部分切除术对围手术期患者机体炎性反应及免疫功能的影响。方法选取行腔镜甲状腺部分切除术患者30例作为观察组,同期行开放小切口甲状腺手术患者30例作为对照组,记录2组手术时间、术中出血量、术后引流量、住院时间及术后并发症发生情况,检测围手术期各个时段白细胞(WBC)、C反应蛋白(CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平及血清Ig A、Ig G、Ig M、CD3^+、CD4^+、CD4^+/CD8^+水平,并进行对比分析。结果观察组术中出血量少于对照组(P<0.05),住院时间短于对照组(P<0.05),术后并发症发生率低于对照组(P<0.05)。观察组术后1 d及3 d CRP、IL-6、TNF-α水平均显著低于对照组(P均<0.05),Ig A、Ig G、Ig M、CD3^+、CD4^+、CD4^+/CD8^+均明显高于对照组(P均<0.05)。结论腔镜下甲状腺部分切除术能明显减少术中出血量,缩短住院时间,降低术后并发症发生率,对机体炎性反应及免疫功能影响小,体现出其微创优势。

Objective It is to observe the influence of endoscopic partial thyroidectomy on the inflammatory and immune indexes of patients during perioperative period. Methods 30 cases with partial thyroidectomy by endoscope were selected as the observation group and 30 cases with partial thyroidectomy by small incision were selected as the control group at the same time. The operation time, intraoperative blood loss, postoperative flow, hospitalization time and postoperative complications were recorded. The Inflammation factors level including WBC, CRP, IL -6, TNF -c t, and the immune index including IgA, IgG, IgM, CD3 ~ , CD4 ＊ , CD4 ~/CD8 ~ were detected and compared in different periods during perioperative period. Results In the observation group, the intraoperative blood loss was lesser than that in the control group, and the hospitalization time was shorter than that in the control group, the postoperative complications rate was lower than that in the control group, and there were significant differences （ all P 〈 0.05 ）. The levels of serum CRP, IL - 6, and TNF - ot in the observation group were significantly lower and the levels of serum IgA, IgG, IgM and CD3 ＋ , CD4 ＋ , CD4 ＋/CD8 ＋ were significantly higher than those in the control group in the 1, 3 postoperatively day （ all P 〈 0.05 ）. Conclusion Laparoscopic partial thyroidectomy can reduce the intraoperative blood loss, shorten hospitalization time, reduce postoperative complications, and with little influ- ence on inflammatory reaction and immune function, inflammation factor, and protect the immune function, which has an ad- vantages of minimally invasive.