甲状腺良性结节患者运用低位小切口手术、传统甲状腺手术治疗的效果对照及对创伤应激反应的影响

Comparison on the effects of low incision surgery and traditional thyroid surgery for patients with benign thyroid nodules and its impact on traumatic stress response

目的比较不同手术方案在甲状腺良性结节临床治疗中的应用效果及对患者创伤应激反应的影响。方法以110例甲状腺良性结节患者作为观察对象,收集入组患者住院号,按照单双号进行分组,其中55例单号患者列为对照组,55例双号患者列为观察组。对照组给予传统甲状腺手术治疗,观察组给予低位小切口手术治疗。比较两组术中出血量、手术耗时、切口长度、插管时间、住院天数,手术结束时与术后6、12 h的疼痛程度评分,术前1 h、术后24 h创伤应激反应相关指标[肾上腺素(E)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、皮质醇(COR)]水平,术后并发症发生情况,临床疗效。结果观察组术中出血量(40.56±3.15)ml少于对照组的(73.66±1.27)ml,手术耗时(40.66±1.19)min、插管时间(2.33±0.12)d、住院天数(4.55±0.13)d、切口长度(4.21±0.12)cm均显著短于对照组的(64.62±2.08)min、(3.98±0.17)d、(7.01±0.14)d、(6.55±0.35)cm(P<0.05)。手术结束时与术后6 h、术后12 h,观察组疼痛评分分别为(1.49±0.12)、(4.12±0.13)、(3.55±0.14)分,均明显低于对照组同一时间点的(1.75±0.11)、(4.66±0.17)、(4.21±0.19)分(P<0.05)。术前1 h,对比两组E、hs-CRP、IL-6、COR检测水平,可得组间差异均不显著(P>0.05);术后24 h,两组的E、hs-CRP、IL-6、COR水平均显著高于本组术前1 h(P<0.05);术后24 h,观察组E、hs-CRP、IL-6、COR水平分别为(180.33±1.15)ng/ml、(1.59±0.21)mg/L、(3.71±0.12)ng/L、(182.52±2.08)μg/L,均显著低于对照组的(223.15±3.37)ng/ml、(5.62±0.31)mg/L、(5.99±0.17)ng/L、(285.36±6.17)μg/L(P<0.05)。观察组术后并发症总发生率为5.45%(3/55),显著低于对照组的18.18%(10/55)(P<0.05)。观察组总有效率为96.36%,显著高于对照组的80.00%(P<0.05)。结论低位小切口手术治疗甲状腺良性结节综合效果较好,且患者创伤应激反应较小。

Objective To compare the application effect of low incision surgery and traditional thyroid surgery for patients with benign thyroid nodules and its impact on traumatic stress response.Methods 110 patients with benign thyroid nodules were observed.Collect the hospitalization numbers of enrolled patients and group them according to single or double numbers.Among them,55 single number patients were listed as the control group and 55 double number patients were listed as the observation group.The control group received traditional thyroid surgery,while the observation group received low incision surgery.Both groups were compared in terms of intraoperative bleeding volume,surgical time,incision length,intubation time,hospitalization days,pain scores at the end of surgery,6 h after surgery and 12 h after surgery traumatic stress response related indicators[epinephrine(E),ultrasensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),and cortisol(COR)]at 1 h before surgery and 24 h after surgery,occurrence of postoperative complications,and clinical efficacy.Results The intraoperative bleeding volume of the observation group was(40.56±3.15)ml,which was less than(73.66±1.27)ml of the control group;the surgical time of the observation group was(40.66±1.19)min,the intubation time was(2.33±0.12)d,the hospitalization days was(4.55±0.13)d,and the incision length was(4.21±0.12)cm which were significantly shorter than(64.62±2.08)min,(3.98±0.17)d,(7.01±0.14)d,and(6.55±0.35)cm of the control group(P<0.05).The pain scores of the observation group were(1.49±0.12),(4.12±0.13)and(3.55±0.14)points at the end of surgery,6 h after surgery,and 12 h after surgery,which were significantly lower than(1.75±0.11),(4.66±0.17)and(4.21±0.19)points of the control group at the same time point(P<0.05).1 h before surgery,the levels of E,hs-CRP,IL-6 and COR were compared between the two groups,and there were no significant differences between the two groups(P>0.05).24 h after surgery,the levels of E,hs-CRP,IL-6 and COR in both groups were significantly higher than those in this group 1 h before surgery(P<0.05).24 h after surgery,the levels of E,hs-CRP,IL-6 and COR in the observation group were(180.33±1.15)ng/ml,(1.59±0.21)mg/L,(3.71±0.12)ng/L and(182.52±2.08)μg/L,which were significantly lower than(223.15±3.37)ng/ml,(5.62±0.31)mg/L,(5.99±0.17)ng/L and(285.36±6.17)μg/L in the control group at the same time point(P<0.05).The total incidence of postoperative complications in the observation group was 5.45%(3/55),which was significantly lower than 18.18%(10/55)in the control group(P<0.05).The total effective rate of the observation group was 96.36%,which was significantly higher than 80.00%in the control group(P<0.05).Conclusion The comprehensive effect of low incision surgery for the treatment of benign thyroid nodules is better,and the patient's traumatic stress response is less.