低位小切口甲状腺手术治疗甲状腺良性结节疗效探讨

Curative effect of thyroid surgery with lower-sited minor incision in treatment of benign thyroid nodules

目的探讨低位小切口甲状腺手术治疗甲状腺良性结节患者的临床疗效,以及对炎症因子的影响。方法选取2018年1月至2019年1月于本院就诊收治的66例甲状腺良性结节患者为研究对象,根据随机数表法分为对照组33例、观察组33例,对照组采取传统手术治疗,观察组采取低位小切口甲状腺手术治疗。比较2组患者手术相关情况,反流症状指数量表(RSI)评分变化情况;采用酶联免疫吸附法(EIISA)检测2组患者手术前后血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)以及白细胞介素-6(IL-6)变化情况;比较2组术后并发症发生情况;术后对2组患者均进行为期1年的随访,比较2组患者甲状腺肿瘤复发率。结果术后对2组患者均进行为期1年的随访,随访率为100%。观察组手术时间、切口长度、术中出血量、术后引流量以及康复出院时间均少于对照组,术后24 h疼痛视觉模拟评分(VAS)低于对照组(P<0.05);术后2组患者血清CRP、TNF-α、IL-6水平均上升,对照组血清CRP、TNF-α、IL-6水平上升更显著(P<0.05);观察组术后切口粘连、声音嘶哑、吞咽困难以及切口感染等并发症总发生率低于对照组(12%与33%,χ^(2)=4.227,P=0.040);术后3个月2组患者RSI评分均降低,且观察组RSI评分降低更显著(P<0.05);2组患者术后1年内甲状腺结节复发率比较差异无统计学意义(6%与3%,χ^(2)=0.349,P=0.555)。结论临床对于甲状腺良性结节患者采取低位小切口甲状腺手术治疗疗效显著,不仅能优化手术一般情况,减轻疼痛,还能有效降低术后机体炎性反应和术后并发症发生率。

Objective To investigate the clinical efficacy of thyroid surgery with lower-sited minor incision in the treatment of benign thyroid nodules,and its influence on inflammatory factors.Methods A total of 76 patients with benign thyroid nodules admitted to our hospital between January 2018 and January 2019 were included as the subjects in the study.All patients were randomly divided into the control group and study group(n=33 each).The control group was treated with conventional surgery,and the study group received thyroid surgery with lower-sited minor incision.The operation related conditions and the changes of reflux symptom index(RSI)scores were compared between the two groups.Enzyme-linked immunosorbent assay(ELISA)was used to examine the changes of serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in the two groups at baseline and after the operation,and the incidence of postoperative complications was also observed determined.After the operation,the two groups of patients were followed up for one year,and the recurrence rate of thyroid tumors was compared between the two groups.Results Both groups were followed up for 1 year after the operation,and the follow-up rate was 100%.The operation time,incision length,intraoperative blood loss,postoperative drainage volume and time to discharge after rehabilitation in the study group were less than those in the control group,and the VAS score at 24h after the operation was lower than that in the control group(all P<0.05).After the operation,the levels of serum CRP,TNF-αand IL-6 in the two groups increased,and the levels of serum CRP,TNF-αand IL-6 in the control group increased more significantly(all P<0.05).The total incidence of postoperative complications,such as incision adhesion,hoarseness,dysphagia and incision infection in the study group was lower than that in the control group(12%vs 33%,χ^(2)=4.227,P=0.040).At three months after the operation,the RSI scores in the two groups decreased,and the RSI score in the study group decreased more significantly(P<0.05).There was no difference in the recurrence rate of thyroid nodules within 1 year after operation between the two groups(6%vs 3%,χ^(2)=0.349,P=0.555).Conclusion Thyroid surgery with lower-sited minor incision is significantly effective in the clinical treatment of benign thyroid nodules.It may not only optimize the general condition of operation,reduce pain,but also effectively reduce the incidence of postoperative inflammatory reaction and postoperative complications.