摘要
目的:探讨乳晕入路腔镜甲状腺切除在结节性甲状腺肿患者中的临床应用价值。方法:回顾性选取赣南医学院第二附属医院普外科2019年2月—2022年2月收治的行经乳晕入路腔镜甲状腺切除的结节性甲状腺肿患者50例纳入观察组,同期行传统开放式甲状腺切除术的35例结节性甲状腺肿患者纳入对照组。对比两组手术情况(手术时间、术中出血量等)、手术炎症反应及应激反应指标[白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、肾上腺素(AD)、皮质醇(Cor)]、临床症状改善情况[嗓音障碍指数(VHI)、吞咽障碍评分量表(SIS)]、手术切口情况[温哥华瘢痕评定量表(VSS)、满意度数字评分系统(NSS)]及并发症发生情况。结果:观察组手术时间较对照组长,术中出血量较对照组少,术后24 h视觉模拟评分法(VAS)评分较对照组低,住院时间较对照组短,差异均有统计学意义(P<0.05)。术后,两组WBC、hs-CRP、AD及Cor水平均较术前升高(P<0.05),且观察组术后上述指标水平均较对照组低,差异均有统计学意义(P<0.05)。术后,两组VHI评分和SIS评分均较术前降低,差异均有统计学意义(P<0.05);但两组间的VHI评分和SIS评分差异均无统计学意义(P>0.05)。术后1个月随访时,观察组VSS评分较对照组低,满意度NSS评分较对照组高,差异均有统计学意义(P<0.05)。观察组并发症总发生率为8.00%,对照组总发生率为11.43%,两组差异无统计学意义(P>0.05)。结论:经乳晕入路的腔镜手术用于结节性甲状腺肿患者甲状腺切除具有良好的疗效和安全性,可有效改善声音嘶哑、吞咽困难等临床症状,且相较于传统开放式甲状腺切除术术中出血量更少、术后24 h疼痛评分更低、术后炎症应激指标水平更低、住院时间更短、瘢痕评分及切口满意度更优,但手术时间相对较长。
Objective:To explore the clinical application value of endoscopic thyroidectomy via the areola approach in patients with nodular goiter.Method:A total of 50 patients with nodular goiter who underwent endoscopic thyroidectomy via the areola approach in Department of General Surgery of the Second Affiliated Hospital of Gannan Medical University from February 2019 to February 2022 were retrospectively selected and included in observation group,and 35 patients with nodular goiter who received traditional open thyroidectomy during the same period were enrolled as control group.The surgical conditions(surgical time,intraoperative blood loss,etc),surgical inflammatory response and stress response indicators[white blood cell count(WBC),highsensitivity C reactive protein(hs-CRP),adrenaline(AD),cortisol(Cor)],improvement of clinical symptoms[voice handicap index(VHI),swallowing impairment scale(SIS)],surgical incision condition[Vancouver scar scale(VSS),numerical scale system(NSS)of satisfaction]and occurrence of complications were compared between the two groups.Result:The surgical time in observation group was longer than that in control group,and the intraoperative blood loss was less that in the control group,and visual analogue scale(VAS)score at 24 h after surgery was lower than that in the control group,and the hospital stay was shorter than that in the control group(P<0.05).The levels of WBC,hs-CRP,AD and Cor after surgery in both groups were enhanced compared with those before surgery(P<0.05),and the above levels in observation group were lower than those in control group after surgery(P<0.05).The VHI scores and SIS scores in both groups after surgery were declined compared to those before surgery(P<0.05),but the differences were not statistically significant in VHI score and SIS score between the two groups(P>0.05).At the follow-up 1 month after surgery,the VSS score in observation group was lower than that in control group,while the NSS of satisfaction score was higher than that in control group(P<0.05).The total incidence rate of complications in observation group was 8.00%and that in control group was 11.43%,the difference was not significant(P>0.05).Conclusion:Endoscopic surgery via the areola approach for thyroidectomy in patients with nodular goiter has good efficacy and safety,and can effectively improve clinical symptoms such as hoarseness and dysphagia.Compared with traditional open thyroidectomy,it has less intraoperative blood loss,lower pain score at 24 h after surgery,lower levels of surgical inflammatory response and stress response indicators,shorter hospital stay,better scar score and incision satisfaction,but has relatively longer surgical time.
作者
何小红
HE Xiaohong(The Second Affiliated Hospital of Gannan Medical University,Xinfeng 341600,China)
出处
《中国医学创新》
CAS
2023年第24期59-63,共5页
Medical Innovation of China
