经胸乳入路腔镜甲状腺手术与传统开放手术对创伤反应的影响

Influence of endoscopic thyroidectomy via chest-breast approach and traditional open thyroidectomy on trauma response

目的 比较经胸乳入路腔镜甲状腺腺叶切除术(ETCBA)与传统开放甲状腺腺叶切除术(TOT)对机体创伤反应的影响。方法 99例成人单侧良性甲状腺肿物患者分为TOT组(n=56)和ETCBA组(n=43),比较两组术前2 h及术后12、24 h血清肿瘤坏死因子α、白细胞介素6、超敏C反应蛋白水平的变化;同时比较两组患者手术时间、术中出血量、术后引流量及切口美容满意度的差异。结果 两组患者术后12、24 h血清肿瘤坏死因子α、白细胞介素6、超敏C反应蛋白均较术前2 h升高(P<0.01),但组间差异无统计学意义(P>0.05)。ETCBA组手术时间长于TOT组(P<0.01),但术中出血量、术后引流量少于TOT组(P<0.01),术后切口美容满意度评分高于TOT组(P<0.01)。结论 与TOT手术相比,ETCBA手术时间长,但术中出血量、术后引流量少,术后切口美容满意度高,对机体创伤反应的影响相似。

Objective To comparatively study the influence of endoscopic thyroidectomy via chest-breast approach(ETCBA) and traditional open thyroidectomy(TOT) on trauma response. Methods A total of 99 adult patients with unilateral benign thyroid neoplasms were divided into two groups, 56 cases in the TOT Group and 43 cases in the ETCBA Group. The serum levels of tumor necrosis factor-α, interleukin-6 and hypersensitive C reactive protein at 2 h preoperatively and at 12 h and 24 h postoperatively were compared between two groups. At the same time, the operation time, intraoperative blood loss,postoperative drainage and satisfaction to cosmetic effect of incision were also compared between the two groups. Results The serum tumor necrosis factor-α, interleukin-6 and hypersensitive C reactive protein at 12 h and 24 h postoperatively were significantly higher than those at 2 h preoperatively in the two groups(P<0.01), but there were no significant differences between the two groups(P>0.05). The ETCBA Group had a longer operation time than the TOT Group(P<0.01), but had the intraoperative blood loss and postoperative drainage lower than the TOT Group(P<0.01) and had the satisfaction score for cosmetic effect of incision better than the TOT Group(P<0.01). Conclusion Compared with TOT, ETCBA requires a longer operation time, but has less intraoperative blood loss and postoperative drainage. ETCBA has a better satisfaction to the cosmetic effect of incision than the TOT Group. There is similar trauma response between the two groups.