新冠肺炎疫情防控常态化下甲状腺外科的诊疗经验

Experience of thyroid surgery under the normalization of prevention and control of COVID-19 epidemic

目的探讨甲状腺外科实施新冠肺炎疫情防控常态化下诊疗策略的可行性。方法回顾性分析389例因甲状腺疾病住院手术的患者,分为对照组(2018年12月—2019年11月)和研究组(2020年12月—2021年11月)。对照组采取新冠肺炎疫情前正常的诊疗策略,研究组采用依国家政策及医保规定制订的新冠肺炎疫情防控常态化下的诊疗策略。统计两组的一般资料、手术方式、并发症和患者满意度。结果两组性别、年龄、肿瘤位置、手术类型、清扫淋巴结总数、转移淋巴结数目等比较差异无统计学意义(P>0.05)。研究组比对照组有更多的恶性肿瘤(P<0.001),肿瘤平均直径更小(P=0.001),住院费用更低(P<0.001)。研究组的双侧甲状腺腺叶切除+单侧颈中央区淋巴结清扫术、双侧甲状腺腺叶切除+双侧颈中央区淋巴结清扫术的构成比高于对照组(P<0.01)。两组暂时性声音嘶哑、暂时性手足抽搐、皮下积液、术后出血及并发症总发生率比较差异均无统计学意义(P>0.05)。未出现永久性声音嘶哑、永久性手足抽搐、术后感染。两组患者满意度比较差异无统计学意义(P>0.05)。病区未出现确诊或疑似新冠肺炎的患者,科室正常运转,未耽误群众治疗。结论在疫情防控常态化下实施新的诊疗策略后,保证了入院患者数量,尤其是恶性肿瘤患者的及时救治,且并发症无增加,患者满意度无下降,可在临床推广实施。

Objective To investigate the feasibility of implementing a treatment strategy in thyroid surgery under the normalization of prevention and control of COVID-19 epidemic.Methods A retrospective analysis was conducted on 389 hospitalized patients with thyroid disease who underwent surgery,and all patients were divided into control group(December 2018 to November 2019)and study group(December 2020 to November 2021).The control group were given normal treatment strategy before COVID-19 epidemic,and the study group were given the treatment strategy under the normalization of prevention and control of COVID-19 epidemic according to the national policy and health insurance regulations.In addition,general data,surgical methods,complications and patient satisfaction were counted.Results There was no statistically significant difference in gender,age,tumor location,surgical type,total number of cleaned lymph nodes,and the number of metastatic lymph nodes between the two groups(P>0.05).Compared with the control group,the study group had more malignant tumors(P<0.001),smaller mean tumor diameter(P=0.001),and lower hospitalization costs(P<0.001).The constituent ratio of bilateral thyroid lobectomy+unilateral cervical lymph node dissection,and bilateral thyroid lobectomy+bilateral cervical lymph node dissection in the study group was higher than that in the control group(P<0.01).There was no statistically significant difference in the total incidence of temporary hoarseness,temporary hand and foot convulsions,subcutaneous fluid accumulation,postoperative bleeding,and complications between the two groups(P>0.05).No permanent hoarseness,permanent hand and foot twitching,or postoperative infection were found.There was no statistically significant difference in patient satisfaction between the two groups(P>0.05).There were no confirmed and suspected novel coronal pneumonia patients in the ward,and the department operated normally without delaying the treatment of other patients.Conclusion After the implementation of the new treatment strategy under the normalization of prevention and control of COVID-19 epidemic,the number of patients admitted to hospital are ensured,especially the timely treatment of patients with malignant tumors.And there is no increase in complications and no decrease in patient satisfaction,which can be promoted and implemented in clinical practice.