不同手术方案对甲状腺肿瘤患者围术期应激及机体免疫功能的影响

Effects of different surgical procedures on perioperative stress and immune function in patients with thyroid tumor

目的探讨不同手术方案对甲状腺肿瘤患者围术期应激及机体免疫功能的影响。方法选取2013年3月—2015年3月期间收治的甲状腺肿瘤患者77例,按手术方案分为研究组41例和对照组36例,研究组在腔镜辅助下行颈部小切口手术,对照组行传统开放手术。观察两组手术基本情况包括手术时间、术中出血量和住院时间,并比较两组患者围术期应激及机体免疫功能相关指标的差异,包括CD3^+、CD4^+、体温及C反应蛋白(C reactive protein,CRP)浓度。结果观察组手术时间为(42.43±11.02)min、住院时间为(34.20±8.32)d,均显著短于对照组,手术出血量为(4.16±0.65)m L,显著低于对照组(P<0.05);术前24 h两组体温、CRP、CD3+和CD4+比较差异均无统计学意义(P>0.05),观察组术后最高体温为(36.46±0.21)℃,显著低于对照组,术后48和72 h的CRP为(20.29±1.39)和(12.46±1.70)mg/L,显著低于对照组(P<0.05);观察组术后48 h的CD3+显著高于对照组(P<0.05),但两组术后48 h的CD3+及术后48和72 h的CD4+比较均无明显差异(P>0.05)。结论与传统开放手术相比,腔镜辅助颈部小切口手术治疗甲状腺肿瘤患者手术时间和住院时间更短、术中出血量更少,对患者应激反应影响较小,两种手术方案对患者机体免疫功能的影响无显著差异,因此临床上可优先选择腔镜辅助颈部小切口手术治疗甲状腺肿瘤患者。

Objective To investigate the effects of different surgical procedures on perioperative stress and immune function in patients with thyroid tumor. Methods Seventy-seven patients with thyroid tumor treated between March 2013 and March 2015 were selected and divided into observation group（n=41） and control group（n=36）according to surgical procedures. Patients in study group received endoscope-assisted neck micro-incision treatment,and those in control group underwent traditional open surgery. The general conditions of operation in these two groups including operation time,volume of blood loss during operation and hospitalization time were observed,and the perioperative stress and immune function related parameters including CD3^＋,CD4^＋,body temperature and C reactive protein（CRP） levels were compared between two groups. Results The operation time and hospitalization time in observation group was（42.43±11.02）min and（34.20±8.32）d,respectively,which was significantly shorter than that in control group（P〈0.05）. The volume of blood loss during operation in observation group was（4.16 ± 0.65）m L,which was significantly lower than that in control group（P〈0.05）. There was no significant difference in body temperature,CRP,CD3＋and CD4＋24 h before operation between two groups（P〈0.05）. The highest postoperative temperature in observation group was（36.46 ± 0.21）℃,which was significantly lower than that in control group（P〈0.05）. CRP in observation group 48 h and 72 h after operation were（20.29 ± 1.39）mg/L and（12.46 ± 1.70）mg/L,respectively,which were significantly lower than those in control group（P〈0.05）.There was no significant difference between two groups in CD3＋48 h after operation and in CD4＋48 h and 72 h after operation（P〉0.05）. Conclusion Compared with traditional open surgery,endoscope-assisted neck micro-incision treatment for patients with thyroid tumor can reduce operation time,hospitalization time and intraoperative blood loss,and has less influence on the stress reaction of patients. While there is no significant difference in the influence on the immune function of patients between two procedures. Therefore,endoscope-assisted neck micro-incision treatment can be a priority selection for patients with thyroid tumor in clinical practice.