Discomfort in the chest wall approach area in patients undergoing endoscopic thyroidectomy by a gasless unilateral axillary approach(GUA)
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维普
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目的 调查无充气腋窝入路腔镜甲状腺手术(endoscopic thyroidectomy by a gasless unilateral axillary approach,GUA)患者胸壁入路区不适症状,并分析影响因素,为制定针对性的改善措施提供依据.方法 选取郑州大学第一附属医院甲状腺外科2023年5月至2023年8月153例GUA患者为研究对象,术前1 d收集一般资料调查表,术后1 d及术后3 d评估疼痛量表,术后1个月评估疼痛和麻木感量表,并对收集的数据进行整理和分析.对基线资料组间比较,根据变量的不同类型采用t检验或x2检验.将患者分为中度以下疼痛组(术后两次平均VAS评分＜4),中度及以上疼痛组(术后两次VAS平均评分≥4);轻微麻木组(术后VAS评分＜4),中重度麻木组(术后VAS评分≥4).分别以疼痛不适和麻木不适为因变量进行多因素二元Logistic回归,寻找可能的影响因素.结果 回收有效问卷153份.中度以下疼痛组患者总计125例,中度及以上疼痛组患者总计28例,轻微麻木组患者总计94例,中重度麻木组患者总计59例.多因素二元Logis-tic 回归结果显示,运动习惯(OR=0.07,95％CI=0.006,0.409)、手术时长(OR=1.026,95％CI=1.001,1.054)、引流液总量(OR=1.122,95％CI=1.07,1.198)、引流管留置时间(OR=0.012,95％CI=0.00,0.187),对胸壁入路区出现不适有影响,差异具有统计学意义(P＜0.05).性别、体质指数(body mass index,BMI)、婚姻状况、学历、职业、是否经惯用手侧腋窝手术、有无烟酒史、术中出血量、住院时间对胸壁入路区不适无影响,差异无统计学意义(P＞0.05).结论 运动习惯、手术时长、引流液总量、引流管留置时间是引起GUA患者胸壁入路区不适感的独立预测因素.
Objective To investigate the discomfort of chest wall approach area in patients undergoing en-doscopic thyroidectomy by a gasless unilateral axillary approach(GUA),and to analyze its influencing factors.To provide a basis for the development of targeted improvement measures.Methods A total of 153 patients with GUA from May.2023 to Aug.2023 in the Department of Thyroid Surgery,the First Affiliated Hospital of Zheng-zhou University were selected as the study subjects.The general information questionnaire was collected one day before operation,the pain scales were assessed one day and three days after operation,and the pain and numbness scales were assessed one month after operation.The t test or x2 test was used for comparison of baseline data be-tween groups according to different types of variables.The patients were divided into two groups:less than moder-ate pain group(two postoperative average VAS scores＜4)and more than moderate pain group(two postoperative average VAS scores ≥4).Mild numbness group(postoperative VAS score＜4);Moderate and severe numbness group(postoperative VAS score ≥4).Multivariate binary Logistic regression was performed with pain discomfort and numbness discomfort as dependent variables to find possible influencing factors.Results A total of 153 valid questionnaires were collected.There were 125 patients in the moderate pain group;There were 28 patients in the moderate and above pain group.There were 94 patients in the mild numbness group.There were 59 patients in the moderate to severe numbness group.Multivariate binary Logistic regression results showed that,exercise habits(OR=0.07 95％CI=0.006,0.409),operation duration(OR=1.026 95％CI=1.001,1.054),total drainage volume(OR=1.122 95％CI=1.07,P＜0.05),1.198),and drainage tube indwelling time(OR=0.012 95％CI=0.0,0.187)had an impact on the discomfort of the chest wall approach area,and the difference was statistically significant(P＜0.05).Gender,BMI,marital status,education,occupation,handed-side surgery,handed-side axillary surgery,smokess and alcohol history,intraoperative blood loss,and length of hospital stay had no effect on the discomfort of chest wall approach area,and the difference was not statistically significant(P＞0.05).Conclusion Exercise hab-its,operation duration,total drainage volume,and drainage duration are independent predictors of discomfort in GUA patients.
Axillary approachEndoscopic thyroidectomyChest wall approach area
维普
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