微波消融术与传统开放手术治疗甲状腺良性结节对机体应激反应的比较

Comparative study of systemic stress responses between microwave ablation and traditional open surgery for benign thyroid nodules

目的比较微波消融术与传统开放手术治疗甲状腺良性结节对机体应激反应的影响。方法选取2016年2月至9月攀枝花市中心医院收治的良性甲状腺结节患者108例,随机分成微波组(57例)和开放组(51例),分别行超声引导下的甲状腺结节微波消融术和传统开放手术。比较两组患者术前1 d、术后8、24和48 h的体温、白细胞计数(WBC)、疼痛视觉模拟评分(VAS)、皮质醇(COR)、超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)水平。结果术后24 h开放组的体温(37.6±0.35)°C,高于微波组(36.5±0.45)°C,差异有统计学意义(t=2.276,P=0.025)。术后24 h和48 h开放组WBC高于微波组[(11.26±2.25)×10~9/L vs(7.41±1.25)×10~9/L,t=2.241,P=0.031;(10.35±1.42)×10~9/L vs(6.28±1.51)×10~9/L,t=2.806,P=0.004]。术后8、24、48 h开放组的VAS、hsCRP、IL-6、COR均高于同时间点的微波组,差异均有统计学意义(t=2.685、3.172、3.704,P=0.007、0.002、0.000;t=2.990、3.560、3.967,P=0.002、0.001、0.000;t=2.405、2.495、2.763,P=0.016、0.013、0.006;t=2.357、2.647、2.924,P=0.019、0.008、0.003)。结论微波消融术对甲状腺良性结节患者机体应激反应的影响明显小于开放手术,显示了微波手术微创的优越性。

Objective To compare differences in systemic stress responses between ultrasound-guided percutaneous microwave ablation and traditional open surgery for benign thyroid nodules.Methods One hundred and eight patients with benign thyroid nodules enrolled into Panzhihua Central Hospital between February and September 2016 were randomized to microwave ablation group （n=57） or traditional open surgery group （n=51）. Body temperature, white blood cell （WBC） count, visual analogue scale （VAS） scores, plasma 1evels of cortiso1 （COR）, high sensitive C-reactive protein （hs-CRP）, interleukin-6 （IL-6） were recorded preoperatively （baseline）, 8, 24, and 48 h following surgery.Results Body temperature was higher in open surgery group （37.6±0.35）℃ than microwave ablation group （36.5±0.45）℃ 24 h postoperatively （t=2.276,P =0.025）. WBC on 24 h and 48 h postoperatively was respectively higher in open surgery group than microwave ablation group [（11.26±2.25）×109/Lvs （7.41±1.25）×109/L,t=2.241,P=0.031; （10.35±1.42）×109/Lvs （6.28±1.51）×109/L,t=2.806,P=0.004]. VAS scrore, hs-CRP, IL-6 and COR were all respectively higher in open surgery group than microwave ablation group on 8, 24 and 48 h postoperatively （t=2.685, 3.172, 3.704,P=0.007, 0.002, 0.000;t=2.990, 3.560, 3.967,P=0.002, 0.001, 0.000;t=2.405, 2.495, 2.763,P=0.016, 0.013, 0.006;t=2.357, 2.647, 2.924,P=0.019, 0.008, 0.003）.Conclusions There is less systemic stress response after microwave ablation than traditional open surgery for benign thyroid nodules. Microwave ablation is characterized as minimal invasion for benign thyroid nodules.