两种微创术式治疗甲状腺微小乳头状癌的疗效及对氧化应激指标的影响

Effect of Two Minimally Invasive Procedures in the Treatment of Papillary Thyroid Microcarcinoma and Their Influence on Oxidative Stress Indicators

目的探讨两种微创术式对甲状腺微小乳头状癌的临床治疗价值。方法选取2018年7月至2020年6月收治的84例甲状腺微小乳头状癌患者,以随机数字表法分组,观察组42例,行改良Miccoli手术,对照组42例,行完全腔镜手术,对两组患者手术及术后恢复情况,术后疼痛程度,术前、术后48h氧化应激指标变化,术后并发症予以观察。结果与对照组比较,观察组术中出血量明显较少,手术时间、术后引流时间、术后住院时间明显较短(P<0.05),两组淋巴结清扫数比较,无明显差异(P>0.05);观察组术后12h、术后24h、术后48h视觉模拟评分法(VAS)评分与同期对照组比较,明显较低(P<0.05);术前,两组血清谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平比较,无明显差异(P>0.05),术后48h,观察组上述指标情况与同期对照组比较,明显较好(P<0.05);观察组术后并发症发生率为4.76%,与对照组7.14%比较,无明显差异(P>0.05)。结论改良Miccoli手术与完全腔镜手术治疗甲状腺微小乳头状癌均具有较好效果及安全性,但改良Miccoli手术可减少手术时间及术中出血量,减轻术后疼痛,降低术后氧化应激指标水平,更利于术后恢复。

Objective To explore the clinical value of two minimally invasive procedures for papillary thyroid microcarcinoma.Methods A total of 84 patients with papillary thyroid microcarcinoma admitted from July 2018 to June 2020 were divided into two groups by the random number table method,42 cases in the observation group underwent modified Miccoli operation,42 cases in the control group underwent complete laparoscopic operation.The operation and postoperative recovery,the degree of postoperative pain,the changes of oxidative stress indicators before and 48h after operation,the postoperative complications of the two groups were observed.Results Compared with the control group,the intraoperative blood loss of the observation group was significantly less,the operation time,postoperative drainage time and postoperative hospital stay of the observation group were significantly shorter(P<0.05),there was no significant difference in the number of lymph node dissections between the two groups(P>0.05).The visual analogue scale(VAS)scores of the observation group at 12h,24h,and 48h after operation were compared with the control group at the same period,significantly lower(P<0.05).Before operation,there were no significant difference in the serum glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)and malondialdehyde(MDA)levels between the two groups(P>0.05),48h after operation,compared with the control group at the same period,the above indicators in the observation group were obviously better(P<0.05).The incidence of postoperative complications in the observation group was 4.76%,compared with 7.14%in the control group,had no significant difference(P>0.05).Conclusion Modified Miccoli operation and complete laparoscopic soperation for the treatment of papillary thyroid microcarcinoma are both effective and safe,but modified Miccoli operation can reduce operation time and intraoperative blood loss,reduce postoperative pain,and reduce postoperative oxidative stress indicators levels,it is more conducive to postoperative recovery.