免充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响

Influence of air-free transaxillary approach in total endoscopic thyroidec-tomy on recurrent laryngeal nerve function

目的 探讨免充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响。方法 选取2019年1月至2021年12月在柳州市妇幼保健院乳甲外科接受治疗的100例甲状腺癌患者作为研究对象,采用随机数字表法将其分为观察组(n=50)和对照组(n=50)。观察组患者采用免充气经腋窝入路全腔镜下甲状腺手术,对照组患者采用经颈前入路开放手术。比较两组患者的手术时间、术中出血量、住院时间,比较两组患者术后1、2、3 d疼痛感和炎症因子水平,比较两组患者手术前后免疫功能和生活质量,比较两组患者并发症发生情况。结果 观察组患者手术时间长于对照组,住院时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);观察组患者术后1、2、3 d的视觉模拟评分法(VAS)评分均低于对照组,差异有统计学意义(P<0.05);观察组患者术后1、2、3 d的C反应蛋白水平和白细胞介素-6水平均低于对照组,差异有统计学意义(P<0.05);两组患者术后的CD3~+、CD4~+/CD8~+水平均低于本组术前,观察组患者术后CD3~+、CD4~+/CD8~+均高于对照组,差异有统计学意义(P<0.05);观察组患者术后并发症总发生率低于对照组,差异有统计学意义(P<0.05);两组患者术后生理、心理、环境、社会关系评分均高于本组术前,观察组患者术后生理、心理、环境、社会关系评分均高于对照组,差异有统计学意义(P<0.05)。结论 对甲状腺癌患者进行免充气经腋窝入路全腔镜术,能更加有效地减轻患者手术创伤和术后疼痛感,保护喉返神经,降低术后喉返神经损伤及甲状腺功能减退风险,并减少炎症因子释放,减轻对免疫功能的损伤,提升生活质量水平。

Objective To investigate the effect of air-free transaxillary approach in total endoscopic thyroidectomy on the function of the recurrent laryngeal nerve. Methods From January 2019 to December 2021, 100 patients with thyroid cancer who received treatment in the Department of Breast and Thyroid Surgery of the Liuzhou Maternal and Child Healthcare Hospital were selected as the research subjects, they were divided into the observation group(n=50) and the control group(n=50) according to random number table method. The patients in the observation group were treated with air-free transaxillary approach under total laparoscopic thyroid surgery, and the patients in the control group were treated with open surgery via the anterior cervical approach. The operation time, intraoperative blood loss and hospital stay of the two groups were compared. The pain and inflammatory factors on the 1, 2, and 3 d after the operation were compared between the two groups. The immune function and quality of life of the two groups before and after the operation were compared. The complications of the two groups were compared. Results The operation time of the observation group was longer than that of the control group, the hospital stay was shorter than that of the control group, and the intraoperative blood loss was less than that of the control group, with statistically significant differences(P<0.05). The visual analogue scale(VAS) scores of patients in the observation group on the 1, 2 and 3 d after operation were lower than those in the control group, and the differences were statistically significant(P<0.05). The levels of C reactive protein and interleukin-6 were lower than those in the control group, and the differences were statistically significant(P<0.05). The levels of CD3+and CD4+/CD8+of two groups after operation were lower than those prior operation, while the levels of CD3+and CD4+/CD8+of the observation group were higher than those of the control group, and the differences were statistically significant(P<0.05). The total incidence of postoperative complications in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05). The scores of physiology, psychology, environmental, and social relationship of two groups after surgery were all higher than those before surgery, the scores of physiology, psychology, environmental, and social relationship in the observation group were higher than those in the control group, with statistically significant differences(P<0.05). Conclusion The air-free transaxillary approach in total endoscopic thyroidectomy in patients with thyroid cancer can effectively alleviate surgical trauma and postoperative pain, protect the recurrent laryngeal nerve, and reduce the risk of postoperative recurrent laryngeal nerve injury and hypothyroidism, as well as decrease the release of inflammatory factors,ease the damage to immune function, and improve the quality of life.