全腔镜下手术治疗对分化型甲状腺癌患者围术期指标、炎性因子及认知功能的影响

Effects of Total Endoscopic Thyroidectomy on Perioperative Indicators,Inflammatory Factors and Cognitive Function in Patients with Differentiated Thyroid Cancer

目的分析全腔镜下手术治疗对分化型甲状腺癌(differentiated thyroid carcinoma,DTC)患者围术期指标、炎性因子及认知功能的影响。方法选择2018年6月—2020年6月收治的94例DTC,根据不同的手术方式分为研究组58例(采用全腔镜甲状腺切除术)和对照组36例(采用传统开放性甲状腺切除术)。比较两组手术时间、术中出血量、淋巴结清扫数目及术后引流量等围术期指标,手术前后炎性因子水平、甲状腺功能指标、简明精神状态检查量表(mini-mental state examination,MMSE)评分、疼痛视觉模拟评分法(visual analogue scale,VAS)评分及术后并发症与复发情况。结果研究组手术时间较对照组长,术后住院时间明显短于对照组,术中出血量、术后引流量明显少于对照组,组间比较差异有统计学意义(P<0.01);术后24 h,两组白细胞介素-6(IL-6)、C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)水平均较术前明显升高,且研究组TNF-α、CRP、IL-6水平明显低于对照组,组间比较差异有统计学意义(P<0.01);术后24 h,两组三碘甲状腺原氨酸(T 3)、甲状腺素(T 4)、游离三碘甲状腺原氨酸(FT 3)、游离甲状腺素(FT 4)水平均较术前明显降低,且研究组T 3、FT 3、T 4及FT 4水平显著低于对照组,组间比较差异有统计学意义(P<0.01);术后24 h研究组MMSE评分显著高于对照组,VAS评分显著低于对照组,组间比较差异有统计学意义(P<0.01);两组术后并发症总发生率比较差异无统计学意义(χ^2=0.083,P=0.773),术后随访2个月均未出现复发。结论采用全腔镜甲状腺切除术治疗DTC患者效果显著,可有效减少术中出血量,减轻术后疼痛,降低术后炎性因子水平,有利于改善术后认知功能,且安全性好。

Objective To analyze the effects of total endoscopic thyroidectomy on perioperative indicators,inflammatory factors and cognitive function in patients with differentiated thyroid carcinoma(DTC).Methods A total of 94 DTC patients admitted to our hospital from June 2018 to June 2020 were entered into this study.According to different surgical methods,they are divided into a research group(n=58,total endoscopic thyroidectomy)and a control group(n=36,traditional open thyroidectomy).The duration of operation,intraoperative blood loss,number of lymph node dissection,postoperative drainage and other perioperative indicators,levels of inflammatory factors,thyroid function,and mini-mental state examination(MMSE)score,pain visual analogue scale(VAS)score as well as complications and recurrence were compared between the two groups.Results The duration of operation was longer in the research group than in the control group,whereas the duration of hospital stay,the amount of intraoperative blood loss,and postoperative drainage were significantly shorter or lower than those of the control group,and the difference between the groups was statistically significant(P<0.01).At 24 h after operation,the levels of interleukin-6(IL-6),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)in the two groups were significantly higher than those before operation.The levels of CRP and IL-6 were significantly lower in the research group than in the control group,and the differences between the groups were statistically significant(P<0.01).At 24 h after operation,the levels of triiodothyronine(T 3),thyroxine(T 4),free triiodothyronine(FT 3)and free thyroxine(FT 4)in the two groups were significantly lower than those before surgery,the levels of T 3,FT 3,T 4 and FT 4 of the research group were significantly lower than those of the control group,and the difference between the groups was statistically significant(P<0.01).The MMSE score of the research group was significantly higher than that of the control group at 24 h after operation,while the VAS score was significantly lower than that of the control group.The difference between the groups was statistically significant(P<0.01).There was no significant difference in the total incidence of postoperative complications between the two groups(χ^2=0.083,P=0.773),and there was no recurrence in the postoperative follow-up.Conclusion The total laparoscopic thyroidectomy has a significant effect in the treatment of DTC patients,which can effectively reduce intraoperative blood loss,postoperative pain and inflammatory factor levels,and improve postoperative cognitive function,with good safety.