目的 探讨经腋完全腔镜下胸锁乳突肌间入路术治疗甲状腺乳头状癌的有效性及对甲状腺激素水平的影响.方法 采用前瞻性研究方法,将收治的106例确诊为甲状腺乳头状癌患者按随机数字表法分为对照组、研究组,各53例.对照组行开放手术治疗,研究组接受腋完全腔镜下胸锁乳突肌间入路术治疗.以手术指标、临床治疗效果、视觉模拟评分法(visualanaloguescale,VAS)、瘢痕评定量表(Vancouver)、超敏 C 反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素-6(Interleukin-6,IL-6)、α 肿瘤坏死因子(tumor necrosis factor,TNF-α)以及甲状腺激素水平来评估手术效果.结果 研究组治疗有效率为90.57％,显著高于对照组的75.47％(x2=4.282,P＜0.05).在手术时间、术中出血量、切口长度、术后引流量以及住院时长方面,研究组明显短于对照组(P＜0.05).术后6 h,2组患者VAS评分无显著差异(P＞0.05);VSS评分以及术后24、48 h VAS评分观察组均低于对照组(P＜0.05).治疗前,2组患者的CRP、IL-6和TNF-α的水平无显著性差异(P＞0.05);治疗后,2组患者的CRP、IL-6、TNF-α水平显著下降(P＜0.05),且研究组患者的CRP、IL-6和TNF-α的水平改善程度显著优于对照组(P＜0.05).治疗前,2组患者血清游离三碘甲状腺原氨酸(free triiodothyronine-3,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(thyroid-stimulating hormone,TSH)水平无显著性差异(P＞0.05);治疗后,对照组血清FT3、FT4、TSH水平波动较为明显,组内比较差异具有统计学意义(P＜0.05);研究组FT3、FT4水平与治疗前无显著差异(P＞0.05),研究组TSH水平较治疗前下降(P＜0.05);研究组FT3、FT4水平高于对照组,TSH水平低于对照组(P＜0.05).对照组切口感染、伤口裂开、声音嘶哑、低钙血症、喉返神经损伤等并发症总发生率(24.50％)高于研究组(9.40％),组间比较差异有统计学意义(x2=4.282,P=0.038).结论 经腋完全腔镜下胸锁乳突肌间入路术治疗甲状腺乳头状癌,其临床治疗效果优于传统开放手术,且该手术对患者的甲状腺激素水平的影响较小,整体疗效佳,且安全性较好.
Efficacy of Transaxillary Total Endoscopic Sternocleidomastoid Intermuscular Approach in the Treatment of Papillary Thyroid Carcinoma and Its Effect on Thyroid Hormone Levels
Objective To investigate the efficacy of sternocleidomastoid intermuscular approach under transaxillary total endoscopic in the treatment of papillary thyroid carcinoma and its effect on thyroid hormone levels.Methods A prospective study was conducted on 106 patients diagnosed with papillary thyroid carcinoma.According to the random number table method,they were randomly divided into the control group and the study group,with 53 patients in each group.The control group was given open surgery,while the study group was given sternocleidomastoid intermuscular approach under axillary total endoscopy.Surgical indicators,visual analogue scale(VAS),scar rating scale(Vancouver),hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),α tumor necrosis factor(TNF-α)and thyroid hormone levels were used to evaluate the surgical effect.Results The ef-fective rate of treatment in the study group was 90.57％,which was significantly higher than 75.47％in the control group(x2=4.282,P＜0.05).In terms of operative time,intraoperative blood loss,incision length,postoperative drainage,and length of hos-pital stay were significantly shorter in the study group than in the control group(P＜0.05).At 6h after operation,there was no significant difference in VAS scores between the two groups(P＞0.05).The VAS scores as well as VSS scores at 24h and 48h af-ter operation were lower than those in the control group(P＜0.05).Before treatment,there was no significant difference in the 1-evels of CRP,IL-6 and TNF-α between the two groups(P＞0.05);after treatment,the levels of CRP,IL-6 and TNF-α decreased significantly in the two groups(P＜0.05),and the improvement in the levels of CRP,IL-6 and TNF-α was significantly better in the study group than in the control group(P＜0.05).Before treatment,there was no significant difference in the serum levels of free triiodothyronine-3(FT3),free thyroxine(FT4)and thyroid-stimulating hormone(TSH)between the two groups(P＞0.05).After treatment,the fluctuation of serum FT3,FT4 and TSH levels in the control group was more obvious,and the comparison with-in the groups was statistically significant(P＜0.05).In the study group,the levels of FT3 and FT4 were not significantly different from those before treatment(P＞0.05),and the level of TSH was lower(P＜0.05).The levels of FT3 and FT4 in the study group were higher than those in the control group,and the level of TSH was lower(P＜0.05).The incidence of incision infection,wound dehiscence,hoarseness,hypocalcemia,and recurrent laryngeal nerve injury were higher in the control group(24.50％)than in the study group(9.40％),and the difference between the groups was statistically significant(x2=4.282,P=0.038).Conclusion The clinical effect of sternocleidomastoid intermuscular approach under transaxillary total endoscopic in the treatment of papillary thyroid carcinoma is superior to the traditional open surgery,and the operation has little effect on the thyroid hormone level of pa-tients,with good overall efficacy and good safety.
Transaxillary total endoscopySternocleidomastoid intermuscular approachPapillary thyroid carcinomaThy-roid hormone levels
万方数据
维普
