无充气腋窝入路完全腔镜下甲状腺癌根治术对甲状旁腺功能及相关激素水平的影响分析

Analysis of the Effects of Complete Endoscopic Radical Thyroidectomy with Non-Pneumatic Axillary Approach on Parathyroid Function and Related Hormone Levels

目的:探讨无充气腋窝入路完全腔镜下甲状腺癌根治术(GUA)对甲状旁腺功能及相关激素水平的影响。方法:选择我院于2020年1月至2022年1月甲状腺癌患者116例,运用随机数字表法将入组患者随机分为腔镜组58例与开放组58例。腔镜组患者实施GUA手术治疗,开放组患者实施颈前切口根治术治疗。记录两组围术期指标,术后并发症,术后24h和48h疼痛视觉模拟评分(VAS);术前和术后1个月甲状腺激素水平变化。结果:腔镜组甲状腺癌患者术中失血量少于开放组,甲状腺癌患者手术时间长于开放组,甲状腺癌患者术后引流量多于开放组,甲状腺癌患者术后住院时间短于开放组(P<0.05)。两组甲状腺癌患者术后并发症无明显差异(P>0.05)。腔镜组术后24h和48h甲状腺癌患者VAS评分低于开放组(P<0.05)。两组术后1个月甲状腺癌患者PTH、T3和T4水平低于术前,而TSH水平高于术前(P<0.05);腹腔镜甲状腺癌患者PTH、T3、T4和TSH水平手术前后差值低于对照组(P<0.05)。结论:GUA术治疗甲状腺癌患者对甲状旁腺功能影响小,值得临床借鉴。

Objective:To investigate the effect of complete endoscopic radical thyroidectomy(GUA)with non-pneumatic axillary approach on parathyroid function and related hormone levels.Methods:A total of 116 patients with thyroid cancer in our hospital from January 2020 to January 2022,and the enrolled patients were divided into a endoscopic group of 58 cases and an open group of 58 cases using a random number table method.The endoscopic group was treated with GUA surgery,and the open group was treated with radical neck anterior incision.The changes of perioperative indexes,postoperative complications,and VAS of patients in the two groups were recorded at 24h and 48h after operation;changes in thyroid hormone levels before and 3 days after surgery.Results:Intraoperative blood loss was less in the endoscopic group than in the open group,the duration of surgery was longer in the endoscopic group than in the open group,the postoperative drainage was higher in the endoscopic group than in the open group,and the postoperative hospital stay was shorter in the endoscopic group than in the open group(P<0.05).There was no significant difference in postoperative complications between the two groups(P>0.05).VAS scores were lower in the endoscopic group than in the open group at 24h and 48h.PTH,T3 and T4 levels were lower than preoperative levels,while TSH levels were higher in the two groups at 1 month postoperatively(P<0.05);the difference in PTH,T3,T4 and TSH levels before and after surgery was lower in the laparoscopic thyroid cancer patients than in the control group(P<0.05).Conclusion:The GUA procedure for patients with thyroid cancer has a low impact on parathyroid function and is worthy of clinical consideration.