两种不同手术方式对甲状腺多发结节患者围手术期指标及预后的影响

Effects of Two Different Surgical Methods on Perioperative Indexes and Prognosis in Patients with Multiple Thyroid Nodules

目的:分析甲状腺全切术与甲状腺次全切术对甲状腺多发结节患者围手术期指标及预后的影响。方法:回顾性分析2014年2月-2015年10月本院99例行择期手术治疗的甲状腺多发结节患者的临床资料,根据手术方式不同将其分为观察组(51例)和对照组(48例)。观察组采用甲状腺全切术治疗,对照组采用甲状腺次全切术治疗。记录两组围手术期相关指标(手术时间、术中出血量、术后住院时间)、术后3个月内并发症发生情况和术后12个月复发情况,并比较两组术前及术后3 d创伤应激指标[血钙、C反应蛋白(CRP)、白细胞(WBC)]、术前及术后1个月甲状腺激素[三碘甲状腺原氨酸(TT3)、甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)]变化情况差异。结果:两组术后住院时间及术后3个月并发症发生情况比较,差异均无统计学意义(P>0.05);观察组手术时间长于对照组,差异有统计学意义(P<0.05);观察组术中出血量少于对照组,差异有统计学意义(P<0.05)。术后12个月,观察组复发率为0,明显低于对照组的18.75%,差异有统计学意义(P<0.05)。术后3 d,两组血钙均低于术前,差异均有统计学意义(P<0.05);术后3 d,两组CRP、WBC均高于术前,差异均有统计学意义(P<0.05);但两组血钙、CRP、WBC水平比较,差异均无统计学意义(P>0.05)。两组术前及术后1个月组间及组内血清TT3、TT4、FT3、FT4水平比较,差异均无统计学意义(P>0.05)。结论:甲状腺全切术与甲状腺次全切术均能治疗多发结节性甲状腺肿,但甲状腺全切术可在避免复发的同时,降低术中出血量,亦不增加手术创伤及术后并发症发生风险,于患者预后更有利。

Objective: To analyze the effects of total thyroidectomy and subtotal thyroidectomy on perioperative indexes and prognosis in patients with multiple thyroid nodules. Method: The clinical data of 99 patients with multiple thyroid nodules who underwent selective surgical treatment in our hospital from February 2014 to October 2015 were analyzed retrospectively. According to the different surgical treatment, they were divided into the observation group(51 cases) and the control group(48 cases). The observation group was treated with total thyroidectomy, and the control group was treated with subtotal thyroidectomy. The perioperative indexes(operation time, intraoperative bleeding volume, postoperative hospital stay), complications within 3 months and recurrence within 12 months were recorded. And the changes of serum calcium, C-reactive protein(CRP), WBC, thyroid hormones(TT3, TT4, FT3, FT4) were compared before and 3 days after operation. Result: There were no significant differences between the two groups in postoperative hospital stay and postoperative complications at 3 months after operation(P>0.05). The operation time in the observation group was longer than that in the control group, the difference was statistically significant(P<0.05). The intraoperative blood loss in the observation group was less than that in the control group, the difference was statistically significant(P<0.05). 12 months after operation, the recurrence rate in the observation group was 0, significantly lower than 18.75% in the control group, and the difference was statistically significant(P<0.05). 3 days after operation, the blood calcium in the two groups were lower than those before operation, the differences were statistically significant(P<0.05). 3 days after operation, CRP and WBC in the two groups were higher than those before operation, the differences were statistically significant(P<0.05). However, there were no significant differences in serum calcium, CRP and WBC between the two groups(P>0.05). There were no significant differences in serum TT3, TT4, FT3 and FT4 between the two groups before and 1 month after surgery(P>0.05). Conclusion: Both total thyroidectomy and subtotal thyroidectomy can treat multiple nodular goitre, but total thyroidectomy can reduce the intraoperative blood loss while avoiding recurrence, and not increase the risk of surgical trauma and postoperative complications, which is more favorable for the prognosis of patients.