微波消融与腔镜手术在甲状腺良性肿块中的疗效对比

Therapeutic effects of microwave ablation versus endoscopic surgery for benign thyroid tumors

目的对比研究微波消融术与腔镜手术治疗甲状腺良性肿块临床效果。方法回顾性分析2016年1月至2018年6月在汕头大学医学院第二附属医院行甲状腺手术治疗的66例患者的临床资料,其中34例行甲状腺肿块微波消融术为消融组,32例行腔镜甲状腺肿块切除术为腔镜组。比较两组手术时间、术中出血量、住院时间、住院费用、手术瘢痕、并发症及手术前后甲状腺激素变化等指标。组间数据比较采用t检验。结果两组患者性别、年龄差异无统计学意义。消融组在手术时间、术中出血量、住院天数、手术瘢痕均少于腔镜组,且差别有统计学意义[分别为(74±26)min比(137±38)min、(3±8)ml比(16±24)ml、(5.3±4.3)d比(8.2±2.9)d、(0.29±0.08)cm比(2.92±0.18)cm,t=7.81、2.76、3.18、73.94,均P<0.01]。两组患者手术前后甲状腺激素变化无统计学意义。消融组并发症发生率为11.8%,与腔镜组的12.5%相比差异无统计学意义(χ^2=0.927,P>0.05)。术后6个月消融组甲状腺结节体积明显缩小并瘢痕化。消融组住院费用较腔镜组增加,差异有统计学意义[(15057±3288)元比(12221±1735)元,t=-4.34,P<0.01]。结论与腔镜手术相比,甲状腺微波消融术虽费用较高,但组织创伤小,手术时间短,出血少,住院天数少,瘢痕小,恢复快,是一种安全有效的手术方式。

Objective To compare the clinical efficacy of microwave ablation and endoscopic surgery in the management of benign thyroid tumors.Methods From January 2016 to June 2018,66 patients with thyroid masses were treated at the Second Affiliated Hospital of Shantou University Medical College,including 34 undergoing microwave ablation(ablation group)and 32 undergoing endoscopic surgery(endoscopic group).Indexes including operation time,blood loss,hospitalization time,hospitalization expenses,surgical scar,the rate of complications,and thyroid gland function were statistically compared between the two groups.Results There was no significant difference in gender orage between the two groups.The operation time,blood loss,hospitalization time,and surgical scar were all significantly lower in the ablation group than in the endoscopic group[(74±26)min vs(137±38)min,(3±8)ml vs(16±24)ml,(5.3±4.3)d vs(8.2±2.9)d,and(0.29±0.08)cm vs(2.92±0.18)cm,respectively,t=7.81,2.76,3.18,and 73.94,P<0.01].There was no significant difference in the levels of thyroid hormones between the two groups before and after the surgery.There was also no significant difference in complication rate between the ablation group and endoscopic group(11.8%vs 12.5%,χ^2=0.927,P>0.05).The thyroid nodules in the ablation group shrank significantly and scarred 6 months after the surgery.Compared with the endoscopy group,the hospitalization expenses of the ablation group were significantly higher[(15057±3288)yuan vs(12221±1735)yuan,t=-4.34,P<0.01).Conclusions Compared with endoscopic surgery,thyroid microwave ablation is a safe and effective surgical method with less tissue trauma,shorter operation time,less bleeding,shorter hospital stay,less scar,and faster recovery.