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
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摘要
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.
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.
引文
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[2]谷彬,钱军,张荧荧.超声刀辅助下低领小切口甲状腺手术的临床分析[J].大连医科大学学报,2016,38(6):562-564.
[3]中华医学会内分泌学分会,中华医学会外科学分会内分泌学组,中国抗癌协会头颈肿瘤专业委员会等.甲状腺结节和分化型甲状腺癌诊治指南[J].中华内分泌代谢杂志,2012,28(10):779-797.
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[5]赵雪桃,安亮,金保红,等.老年甲状腺微小乳头状癌患者的手术治疗效果及预后[J].中国老年学杂志,2013,33(20):5136-5137.
[6]Zhang Z.Efficacy comparison of the anterior low small incision and the traditional incision for treatment of thyroid adenoma[J].Pak J Med Sci,2014,30(5):1119-1122.
[7]Xu Y,Zheng X,Qiu Y,et al.Distinct Metabolomic Profiles of Papillary Thyroid Carcinoma and Benign Thyroid Adenoma[J].J Proteome Res,2015,14(8):3315-3321.
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[9]郑力.改良小切口手术治疗老年甲状腺瘤疾病的临床观察[J].老年医学与保健,2017,23(2):125-127.
[10]刘云宏,甘艳军.腔镜甲状腺切除术与胸骨上小切口甲状腺切除术的疗效对比研究[J].检验医学与临床,2017,14(2):247-249.
[11]刘玉辉,孙均,王松涛,等.老年人甲状腺结节手术切除和微波消融临床疗效和安全性对比分析[J].介入放射学杂志,2016,25(1):44-47.
[12]倪鹏,李红阳.腔镜辅助颈部小切口手术治疗甲状腺良性肿瘤的临床效果[J].中国医药导报,2016,13(16):35-37,49.
[13]连红霞,李秀刚,闫建平.小切口与传统开放手术治疗甲状腺腺瘤效果对比研究[J].中国现代普通外科进展,2017,20(4):291-292,298.
[14]Woo SH.Endoscope-assisted intraoral removal of the thyroid isthmus mass using a frenotomy incision[J].J Laparoendosc Adv Surg Tech A,2013,23(9):787-790.
[15]Gatto F,Grasso LF,Nazzari E,et al.Clinical outcome and evidence of high rate post-surgical anterior hypopituitarism in a cohort of TSH-secreting adenoma patients:Might somatostatin analogs have a role as first-line therapy[J].Pituitary,2015,18(5):583-591.
[16]梁艳辉,赵磊.全腔镜和腔镜辅助小切口甲状腺手术对机体免疫功能的影响[J].医学研究杂志,2016,45(6):101-104.
[2]谷彬,钱军,张荧荧.超声刀辅助下低领小切口甲状腺手术的临床分析[J].大连医科大学学报,2016,38(6):562-564.
[3]中华医学会内分泌学分会,中华医学会外科学分会内分泌学组,中国抗癌协会头颈肿瘤专业委员会等.甲状腺结节和分化型甲状腺癌诊治指南[J].中华内分泌代谢杂志,2012,28(10):779-797.
[4]丁静山.低位小切口甲状腺切除术与传统甲状腺手术在甲状腺结节治疗中的应用效果比较[J].中国基层医药,2017,24(15):2351-2354.
[5]赵雪桃,安亮,金保红,等.老年甲状腺微小乳头状癌患者的手术治疗效果及预后[J].中国老年学杂志,2013,33(20):5136-5137.
[6]Zhang Z.Efficacy comparison of the anterior low small incision and the traditional incision for treatment of thyroid adenoma[J].Pak J Med Sci,2014,30(5):1119-1122.
[7]Xu Y,Zheng X,Qiu Y,et al.Distinct Metabolomic Profiles of Papillary Thyroid Carcinoma and Benign Thyroid Adenoma[J].J Proteome Res,2015,14(8):3315-3321.
[8]Sabuncuoglu MZ,Sabuncuoglu A,Sozen I,et al.Minimally invasive surgery using mini anterior incision for thyroid diseases:a prospective cohort study[J].Int J Clin Exp Med,2014,7(10):3404-3409.
[9]郑力.改良小切口手术治疗老年甲状腺瘤疾病的临床观察[J].老年医学与保健,2017,23(2):125-127.
[10]刘云宏,甘艳军.腔镜甲状腺切除术与胸骨上小切口甲状腺切除术的疗效对比研究[J].检验医学与临床,2017,14(2):247-249.
[11]刘玉辉,孙均,王松涛,等.老年人甲状腺结节手术切除和微波消融临床疗效和安全性对比分析[J].介入放射学杂志,2016,25(1):44-47.
[12]倪鹏,李红阳.腔镜辅助颈部小切口手术治疗甲状腺良性肿瘤的临床效果[J].中国医药导报,2016,13(16):35-37,49.
[13]连红霞,李秀刚,闫建平.小切口与传统开放手术治疗甲状腺腺瘤效果对比研究[J].中国现代普通外科进展,2017,20(4):291-292,298.
[14]Woo SH.Endoscope-assisted intraoral removal of the thyroid isthmus mass using a frenotomy incision[J].J Laparoendosc Adv Surg Tech A,2013,23(9):787-790.
[15]Gatto F,Grasso LF,Nazzari E,et al.Clinical outcome and evidence of high rate post-surgical anterior hypopituitarism in a cohort of TSH-secreting adenoma patients:Might somatostatin analogs have a role as first-line therapy[J].Pituitary,2015,18(5):583-591.
[16]梁艳辉,赵磊.全腔镜和腔镜辅助小切口甲状腺手术对机体免疫功能的影响[J].医学研究杂志,2016,45(6):101-104.