小空间腔镜切除术在良性甲状腺结节治疗中的应用

Application of small space endoscopic thyroidectomy in the treatment of benign thyroid nodules

目的探讨小空间腔镜甲状腺切除手术治疗良性甲状腺结节的疗效及对患者应激反应的影响。方法选取东莞市东南部中心医院普通外科2018年1月1日至2020年9月27日期间收治的80例良性甲状腺结节患者为研究对象,按随机数表法分为对照组和观察组各40例,对照组患者采用常规腔镜手术切除术,观察组患者采用小空间腔镜切除术。比较两组患者的手术时间、术中出血量、引流量、引流时间、术后住院时间、疼痛评分,应激反应[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)水平变化]和并发症发生情况,并评估临床疗效。结果观察组患者的治疗总有效率为97.5%,明显高于对照组的82.5%,差异有统计学意义(P<0.05);观察组患者术中出血量、手术时间、引流量、引流时间、术后住院时间、疼痛评分分别为(16.03±4.56)mL、(53.51±7.21)min、(72.21±20.65)mL、(2.09±0.43)d、(3.51±0.61)d、(3.03±0.91)分,明显少(短)于对照组的(20.05±6.15)mL、(57.48±8.08)min、(85.68±21.33)mL、(2.49±0.58)d、(3.78±0.68)d、(4.08±0.88)分,差异均有统计学意义(P<0.05);观察组和对照组患者术前的hs-CRP、IL-8、TNF-α水平比较差异均无统计学意义(P>0.05);术后48h,两组患者的hs-CRP、IL-8、TNF-α水平均较术前降低,且观察组患者的hs-CRP、IL-8、TNF-α水平分别为(2.19±0.68)mg/L、(16.46±4.61)ng/L、(24.42±4.91)ng/L,明显低于对照组的(8.63±2.01)mg/L、(21.38±3.32)ng/L、(29.17±6.18)ng/L,差异均有统计学意义(P<0.05);观察组患者的并发症发生率为7.5%,明显低于对照组的35.0%,差异有统计学意义(P<0.05)。结论小空间腔镜甲状腺切除术治疗良性甲状腺结节患者能减轻患者的应激反应,临床治疗效果好。

Objective To investigate the effect of small space endoscopic thyroidectomy in the treatment of be-nign thyroid nodules and its impact on stress response of patients.Methods A total of 80 patients with benign thyroid nodules were selected as the research objects,who were admitted to the Department of General Surgery of Dongguan Southeast Central Hospital from January 1,2018 to September 27,2020.According to the random number table method,they were divided into a control group and an observation group with 40 patients in each group.The control group was treated with conventional endoscopic surgery,and the observation group was treated with small space endoscopic surgery.The operation time was compared between the two groups,as well as intraoperative blood loss,drainage volume,drainage time,postoperative hospital stay,pain score,stress response indicators(such as change in level of high sensitivity C-reac-tive protein[hs-CRP],tumor necrosis factor-α[TNF-α],and interleukin-8),and complications;then the clinical efficacy was evaluated.Results The total effective rate of the observation group was 97.5%,which was significantly higher than 82.5%of the control group(P<0.05).The intraoperative blood loss,operation time,drainage volume,drainage time,post-operative hospital stay,and pain score were significantly less(shorter)in the observation group than in the control group,i.e.intraoperative blood loss(16.03±4.56)mL vs(20.05±6.15)mL,P<0.05;operation time(53.51±7.21)min vs(57.48±8.08)min,P<0.05;drainage volume(72.21±20.65)mL vs(85.68±21.33)mL,P<0.05;drainage time(2.09±0.43)days vs(2.49±0.58)days,P<0.05;postoperative hospital stay(3.51±0.61)days vs(3.78±0.68)days,P<0.05;and pain score(3.03±0.91)vs(4.08±0.88),P<0.05.There was no significant difference in the levels of hs-CRP,IL-8 and TNF-αbetween the observation group and the control group before operation(P>0.05).At 48 hours after operation,the levels of hs-CRP,IL-8 and TNF-αin the two groups were lower than those before the operation,and the levels of hs-CRP,IL-8 and TNF-αwere significantly lower in the observation group than in the control group,i.e.hs-CRP level(2.19±0.68)mg/L vs(8.63±2.01)mg/L,P<0.05;IL-8 level(16.46±4.61)ng/L vs(21.38±3.32 ng/L,P<0.05;TNF-αlevel(24.42±4.91)ng/L vs(29.17±6.18)ng/L(P<0.05).The complication rate of the observation group was 7.5%,which was significantly lower than 35.0%of the control group P<0.05.Conclusion Small space endoscopic thyroidectomy for benign thyroid nodules can reduce the stress response of patients,and the clinical treatment effect is good.