不同入路甲状腺腔镜手术方式对甲状腺良性结节患者的影响

Effects of Different Approaches of Endoscopic Thyroidectomy on Patients with Benign Thyroid Nodules

目的研究不同入路甲状腺腔镜手术方式对甲状腺良性结节患者围术期指标、并发症及预后的影响。方法选取2015年6月至2021年6月德阳市人民医院收治的105例甲状腺良性结节患者作为研究对象,根据手术方式分为对照组(n=52)和试验组(n=53),对照组采用锁骨下入路腔镜手术,试验组采用经乳晕入路腔镜手术,观察两组患者围术期指标、并发症及预后。结果两组手术时间、并发症比较,差异无统计学意义(P>0.05),试验组术中出血量及住院时间较对照组少(P<0.05);术后两组患者肾上腺素(E)、皮质醇(COR)较术前略有上升,白细介素(IL-6)指标较术前降低,且试验组优于对照组(P<0.05);术后两组患者VAS评分与术前相比均降低,且试验组优于对照组(P<0.05)。术后试验组美容评分优于对照组(P<0.05)。结论与锁骨下入路腔镜手术相比,乳晕入路腔镜手术具有创面小、出血少、术后疼痛轻等优势,有利于患者早日恢复。

Objective To investigate the effects of different approaches of endoscopic thyroidectomy on perioperative indicators, complications and prognosis of patients with benign thyroid nodules. Methods A total of 105 patients with benign thyroid nodules in Deyang People’s hospital from June 2015 to June 2021 were randomly divided into control group(n=52, endoscopic thyroidectomy via subclavian approach) and experimental group(n=53, endoscopic thyroidectomy via areola approach). Perioperative indicators, complications and prognosis of the two groups were observed. Results There was no statistically significant difference between the two groups in duration of operation and complications(P>0.05). The experimental group had less intraoperative blood loss and shorter hospital stay compared with the control group(P<0.05). After operation, the levels of epinephrine(E) and hydrocortisone(COR) in both groups increased slightly and interleukin(IL-6) level decreased compared with those before surgery, with those in the experimental group lower than those in the control group(P<0.05). Postoperative scores of visual analogue scale(VAS) in both groups decreased compared with those before surgery, and they were better in the experimental group than in the control group(P<0.05). Postoperative cosmetic scores were better in the experimental group than in the control group(P<0.05). Conclusion For patients with benign thyroid nodules undergoing endoscopic thyroidectomy, areola approach is better than subclavian approach since it has has the advantages of smaller postoperative wounds, less intraoperative blood loss, and less postoperative pain, which is more conducive to the early recovery of patients.