微波消融术与传统开放手术在良性甲状腺结节治疗中对机体创伤影响的比较

A Comparative Study on Operative Trauma Between Microwave Ablation and Traditional Open Surgery for Benign Thyroid Nodules

目的比较超声引导下微波消融术与传统开放手术治疗良性甲状腺结节对机体的创伤,评价微波消融术在该病治疗中的应用价值。方法选择90例诊断为良性甲状腺结节需要手术治疗者,根据患者意愿分为微波消融组和传统组,其中45例选择甲状腺微波消融术,45例选择甲状腺传统手术,对2组患者术后12 h白细胞介素(IL-6)、C反应蛋白(CRP)及肿瘤坏死因子α(TNF-α)进行比较。结果微波消融组术后12 h CRP(0.6±0.1)mg/L,明显低于传统手术组(11.9±2.1)mg/L(t=-35.934,P=0.000);IL-6(3.5±1.2)ng/L,明显低于传统手术组(14.3±4.4)ng/L(t=-15.885,P=0.000);TNF-α(43.1±6.1)ng/L,明显低于传统手术组(50.1±2.7)ng/L(t=-7.039,P=0.000)。微波消融组术中出血量(12.3±2.1)ml,明显少于传统手术组(29.2±4.1)ml(t=-24.610,P=0.000);手术时间(29.4±5.4)min明显短于传统手术组(82.2±14.8)ml(P=-22.482,t=0.000);住院时间(1.6±0.7)d明显短于传统手术组(4.2±0.4)d(t=-21.633,P=0.000)。2组术后并发症发生率无显著差异(微波消融组4例,传统手术组6例,χ2=0.450,P=0.502)。结论超声引导下微波消融治疗甲状腺良性结节较传统手术创伤小、美观,术后恢复快,疗效确切,值得临床推广。

Objective To compare the operative trauma between ultrasound-guided percutaneous microwave ablation and traditional open surgery for benign thyroid nodules,to evaluate the value of the microwave ablation in the treatment of the disease.Methods A total of 90 cases of benign thyroid nodules requiring treatment were collected. According to patients’ intention,they were divided into either microwave ablation group（ n = 45） or traditional group（ n = 45）. The serum levels of interleukin（ IL-6）,C-reactive protein（ CRP）,tumor necrosis factor-α（ TNF-α） at 12 h after surgery were compared between the two groups. Results Significant differences were found between the two groups in levels of CRP,IL-6,and TNF-α after operation [（ 0. 6 ± 0. 1） mg / L vs.（ 11. 9 ± 2. 1） mg/L,t =- 35. 934,P = 0. 000;（ 3. 5 ± 1. 2） ng/L vs.（ 14. 3 ± 4. 4） ng/L,t =- 15. 885,P = 0. 000;（ 43. 1 ±6. 1） ng / L vs.（ 50. 1 ± 2. 7） ng / L,t =- 7. 039,P = 0. 000]. And there were also significant differences between the two groups in blood loss,operation time,and postoperative hospitalization time [（ 12. 3 ± 2. 1） ml vs.（ 29. 2 ± 4. 1） ml,t =- 24. 610,P = 0. 000;（ 29. 4 ± 5. 4） min vs.（ 82. 2 ±14. 8） min,t =-22. 482,P =0. 000;（ 1. 6 ±0. 7） d vs.（ 4. 2 ±0. 4） d,t =-21. 633,P = 0. 000].There was no significant difference in complications rate between the two groups： 4 cases in the microwave ablation group and 6 in the traditional open surgery（ χ~2= 0. 450,P = 0. 502）. Conclusions Ultrasound guided percutaneous microwave ablation is characterized by definite curative effect,good cosmetic effect,minimal invasion,and rapid recovery. It is a feasible technique for benign thyroid nodules.