小切口手术治疗老年甲状腺瘤的临床效果及对免疫功能的影响

Clinical analysis of small incision surgery in elderly patients with thyroid tumor and its influence on immune function

目的探讨小切口手术治疗老年甲状腺瘤的临床效果及对免疫功能的影响。方法前瞻性收集2015年1月至2017年1月辽健集团阜新矿总医院(原阜新矿业集团总医院)收治甲状腺瘤疾病患者106例,随机单盲取法分为观察组与对照组各53例。对照组采用传统开放式手术治疗,观察组采用小切口手术治疗。观察两组手术情况,手术前后免疫功能、甲状腺功能变化,治疗期间并发症,并于术后1周行疗效评定。结果观察组手术时间、术中出血量、切口长度及术后引流量均低于对照组(P <0. 05)。观察组术后1 d免疫指标辅助T淋巴细胞(CD3^+)、诱导T淋巴细胞(CD8^+)及CD4^+/CD8^+值均低于术前(P <0. 05),高于对照组同期(P <0. 05),术后3 d高于对照组(P <0. 05),对照组术后不同时间各指标均低于术前(P <0. 05)。观察组手术前后各甲状腺功能指标对比,差异无统计学意义(P>0. 05),对照组术后甲状腺功能指标均低于术前(P <0. 05)。观察组手术后各甲状腺功能指标均显著高于对照组(P <0. 05)。观察组总有效率为96. 23%高于对照组79. 25%(P <0. 05)。观察组并发症发生率为3. 77%低于对照组18. 87%(P <0. 05)。结论小切口术式治疗老年甲状腺瘤患者符合微创治疗要求,对免疫功能、甲状腺功能影响小,术后并发症少,值得临床推广。

Objective To investigate the clinical effect and immune function of small incision surgery for elderly patients with thyroid adenoma.Methods From January 2015 to January 2017,106 cases of thyroid neoplasms were treated ingeneral hospital of mining industry group fuxin.Random single-blind method was divided into observation group and control group,53 cases in each group.The control group was treated with traditional open surgery.The observation group were performed surgical treatment with small incision.The operation conditions of the two groups,and the changes of immune function and thyroid function before and after the operation,and the complications during the treatment were observed.The curative effect was evaluated 1 week after the operation.Results The operative time,intraoperative blood loss,incision length,and postoperative drainage were all lower in the observation group than in the control group(P<0.05).The immune index of helper T lymphocytes(CD3+),induced T lymphocytes(CD8+),and CD4+/CD8+ratio in the observation group were lower than those preoperatively(P<0.05),which was higher than that of the control group at the same time and the index was lower than the preoperative level at the different time points in the control group(P<0.05).There was no significant difference in the thyroid function indexes between the observation group,the preoperative and postoperative groups(P>0.05).The thyroid function index of the control group was lower than that of the preoperative one(P<0.05).The thyroid function indexes of the observation group were significantly higher than those of the control group(P<0.05).The total effective rate in the observation group(96.23%)was higher than that in the control group(79.25%)(P<0.05).The incidence of complications in the group(3.77%)was lower than that in the control group(18.87%)(P<0.05).Conclusion Small incision surgery for elderly patients with thyroid tumors meet the requirements of minimally invasive treatment,less influence on immune function and thyroid function,less postoperative complications,therefore,it is worthy of clinical promotion.