甲状腺癌患者术后肩颈康复锻炼开始时间的研究

Discussion on the starting time of shoulder and neck rehabilitation exercise in patients after endoscopic thyroid cancer surgery through gasless transaxillary endoscopic thyroidectomy

目的探讨无充气腋窝入路腔镜甲状腺癌手术患者最佳肩颈功能康复锻炼的开始时间及其安全性与有效性。方法采用便利抽样法,选取四川省某三级甲等医院2021年行无充气腋窝入路腔镜甲状腺癌手术患者175例作为研究对象,其中5月—8月61例为试验组1,9月—12月60例为试验组2,1月—4月54例为对照组。试验组1、试验组2和对照组术后肩颈康复锻炼开始时间分别为术后48 h、全麻清醒后2 h、术后7 d,统计3组术后引流液总量、引流管留置时间、术后住院时间、术后出血发生率、术后1 d和3 d切口疼痛程度、术后1个月肩颈活动度及生活质量情况。结果3组的引流液总量、引流管留置时间、术后出血发生率、术后住院时间及术后1 d和3 d颈部与腋下切口疼痛比较,差异无统计学意义(P>0.05)。术后1个月,3组颈后伸、左右侧屈、旋转和肩关节外展、内收、前屈、后伸比较,差异具有统计学意义(P<0.001),3组生活质量中术侧颈肩部僵硬、疼痛、麻木、影响休闲娱乐4个方面比较,差异具有统计学意义(P<0.05)。结论无充气腋窝入路腔镜甲状腺癌手术患者麻醉清醒后2 h开始肩颈康复锻炼不会导致创腔出血和影响患者舒适度,能提高患者术后早期生活质量。

Objective To investigate the optimal starting time,safety and effectiveness of shoulder and neck functional rehabilitation exercise for patients undergoing gassless transaxillary endoscopic thyroidectomy(GTET).Methods 175 patients who underwent GTET were selected by convenient sampling,with 121 patients in 2 test groups(61 patients in the test group 1 and 60 patients in the test group 2)and 54 patients in a control group.The starting time of postoperative shoulder and neck rehabilitation training in the control group,test group 1 and test group 2 were postoperative 7 days,postoperative 48 hours and 2 hours after general anesthesia wakening,respectively.The analysis among 3 groups included the amount of drainage(ml),the retention time of drainage tube(h),the postoperative hospital stay(d),the cases of bleeding,the pain score of incision(neck and armpit)at postoperative day 1 and day 3,the range of shoulder and neck movement and the quality of life.Results There was no statistically significant difference in term of drainage amount,retention time of drainage tube,bleeding cases,hospital stay and pain in neck and incisions at postoperative day 1 and day 3 among the 3 groups(P>0.05).The motion range of cervical extension,lateral cervical flexion,cervical rotation,shoulder abduction,shoulder adduction,shoulder flexion and shoulder extension among different groups were statistically significant 1 month after surgery(P<0.001).In term of quality of life(QOL),there were statistically significant differences in aspects of stiffness,pain,numbness of the neck or shoulder,and the impact on leisure and entertainment(P<0.05).Conclusion Starting shoulder neck rehabilitation exercise 2 hours after awake under anesthesia in patients undergoing GTET would not cause bleeding and affect the comfort,and could safely and effectively improve the early QOL of patients in the early postoperative period.