经全乳晕入路腔镜甲状腺切除术对良性甲状腺病变患者应激相关激素水平的影响

Effects of Endoscopic Thyroidectomy via Breast Areola Approach on Stress Related Hormones in Patients with Benign Thyroid Lesions

目的:分析经全乳晕入路腔镜甲状腺切除术对良性甲状腺病变患者应激相关激素水平的影响。方法:收集2016年1月至2018年10月我院收治的82例良性甲状腺病变患者的临床资料,其中接受经全乳晕入路腔镜甲状腺切除术40例,作为腔镜组,接受开放性甲状腺切除术42例,作为开放组,比较两组手术前后血皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)、甲状腺激素(TT3、FT3、TT4、FT4)等应激及相关激素水平的变化,记录术后不同时间点患者视觉模拟评分(VAS)的变化,比较两组手术时间、切口长度、术中出血量、住院时间、引流量,统计术后并发症发生率。结果:①术前,两组Cor、NE、ACTH水平比较差异无统计学意义(P>0.05),术后12h,两组应激激素水平均上升(P<0.05),但腔镜组各激素水平及术前、术后12h变化差值均低于开放组(P<0.05);②术前,两组TSH、TT3、FT3、TT4、FT4水平比较差异无统计学意义(P>0.05),术后12h,两组TSH降低,TT3、FT3上升,与术前比较差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05)。③腔镜组手术时间长于开放组(P<0.05),但其切口长度短于开放组,术中出血量、住院时间、引流量、术后不同时间VAS评分及并发症发生率均低于开放组(P<0.05)。结论:采用经全乳晕入路腔镜甲状腺切除术治疗良性甲状腺病变可减轻患者术后应激反应程度,改善其甲状腺功能,且术中出血少,术后恢复快,并发症发生率低。

Objective:To analyze the effects of endoscopic thyroidectomy via breast areola approach on stress related hormones in patients with benign thyroid lesions.Methods:The clinical data of 82 patients with benign thyroid lesions treated in the hospital from January 2016 to October 2018 were collected.40 cases treated with endoscopic thyroidectomy via breast areola approach were included into the laparoscopic group while 42 cases treated with open thyroidectomy were included into the open group.Changes of stress and related hormones such as serum cortisol(Cor),norepinephrine(NE),adrenocorticotropic hormone(ACTH),thyroid stimulating hormone(TSH),thyroid hormones(TT3,FT3,TT4,FT4)before and after operation were compared between the two groups.Changes of visual analogue scale(VAS)scores at different time points after operation were recorded.The operation time,length of incision,intraoperative blood loss,length of hospital stay,and drainage volume were compared between the two groups.The incidence of postoperative complications was statistically analyzed.Results:①Before operation,there were no statistically significant differences between the two groups in levels of Cor,NE and ACTH(P>0.05).12 hours after operation,the levels of stress hormones increased in the two groups(P<0.05).But the levels of the hormones and the pre-and post-operation difference were lower in the laparoscopic group than in the open group(P<0.05).②There were no statistically significant differences between the two groups in levels of TSH,TT3,FT3,TT4 and FT4 before operation(P>0.05).12 hours after operation,TSH levels decreased while TT3 and FT3 levels increased in the two groups,which was statistically significant compared with pre-operation data(P<0.05),but differences between groups were not statistically significant(P>0.05).③Compared with the open group,the operation time was longer,the length of incision was shorter,the intraoperative blood loss,length of hospital stay,drainage volume,VAS scores at different time points after operation and the incidence of complications were less,shorter or lower in the laparoscopic group(P<0.05).Conclusion:The application of endoscopic thyroidectomy via breast areola approach in the treatment of benign thyroid diseases can reduce postoperative stress reactions and improve the thyroid function.The intraoperative blood loss is little and patients can recover quickly after operation,and the incidence of complications is low.