三种术式治疗甲状腺癌的疗效比较
|
摘要
目的探讨乳晕入路腹腔镜、小切口腹腔镜与开放手术治疗甲状腺癌的疗效及免疫水平改善情况。方法选取138例甲状腺癌患者,随机分为A、B、C三组,各46例,分别给予乳晕入路腹腔镜手术、小切口腹腔镜手术及开放手术。三组数据的分析应用统计学软件SPSS22.0完成。手术相关指标、免疫功能指标用■表示,三样本的比较采用单因素方差分析,两样本的比较采用独立t检验;临床治疗总有效率和术后并发症分析采用四格表χ~2检验;P<0.05为差异有统计学意义。结果 A组手术时间,长于B组及C组(均P<0.05),A组术中出血量、术后引流量均高于B组、低于C组(均P<0.05);A组、B组住院时间均短于C组(P<0.05)。A、B、C三组患者的总有效率分别为95.7%,90.9%,76.1%,A组及B组总有效率均高于C组(P<0.05)。A、B、C三组患者并发症发生率分别为6.5%、8.7%、32.6%(P<0.05),其中A、B两组并发症发生率均低于C组,差异均有统计学意义(均P<0.05)。术后A组及B患者的NK细胞水平均低于C组(P<0.05),A组及B组患者的CD3~+、CD4~+水平均高于C组(P<0.05),即A组患者经手术创伤应激导致的免疫抑制作用最小。结论乳晕入路腹腔镜、小切口腹腔镜均具有良好的手术效果,二者术后并发症发生率均较低,小切口腹腔镜的手术时间、术中出血量及术中引流量等方面均优于乳晕入路腹腔镜,但是乳晕入路腹腔镜对患者的免疫抑制作用较小,二者手术效果均优于开放手术,值得推广应用。
Objective To investigate the efficacy and improvement of immune status in the treatment of thyroid cancer with laparoscopic laparoscopy, small incision laparoscopy and open surgery. Methods A total of 138 patients with thyroid cancer were selected and randomly divided into three groups: group A, group B, and group C, 46 cases in each group, they were given laparoscopic surgery(group A), small incision laparoscopic surgery(group B), and open surgery(group C) respectively. The clinical data was analyzed through statistical software SPSS22.0. The surgically-related indexes and immunological function indexes were expressed as ■. The three-sample comparison was compared by one-way analysis of variance, the two-sample comparison was compared by the independent t\\test, and the total clinical efficacy and postoperative complication rates were compared by a four-cell table χ~2 test. The difference was statistically significant when P<0.05. Results The operation time in group A was longer than those in group B and group C(all P<0.05). The blood loss and postoperative drainage in group A were higher than those in group B and group C(all P<0.05); The hospitalization time in group A and B were shorter than that in group C(P<0.05). The total effective rates in group A, B, and C were 95.7%, 90.9%, and 76.1% respectively. The total effective rate in group A and group B were higher than that in group C(P<0.05). The complication rates in group A, B, and C were 6.5%, 8.7%, and 32.6% respectively, the difference among the three groups was statistically significant(P<0.05), among them, the incidence of complications in A and B groups were lower than those in group C, the differences were statisticallysignificant( all P < 0. 05). After the operation,the NK cell levels in group A and B were lower than that in group C( P < 0. 05). The levels of CD3+,CD4+in group A and B were significantly higher than those in group C( P < 0. 05),so patients in group A had minimal immunosuppression after surgical traumatic stress.Conclusion Areola laparoscopy and small incision laparoscopy have good surgical results,laparoscopy were better than the areola laparoscopy in operation time,intraoperative blood loss and intraoperative drainage of small incision,the incidence of postoperative complications is low in the two surgical methods,however,areola laparoscopy has less immunosuppressive effect on patients,both surgical results are superior than open surgery and worthy of popularization and application.
Objective To investigate the efficacy and improvement of immune status in the treatment of thyroid cancer with laparoscopic laparoscopy, small incision laparoscopy and open surgery. Methods A total of 138 patients with thyroid cancer were selected and randomly divided into three groups: group A, group B, and group C, 46 cases in each group, they were given laparoscopic surgery(group A), small incision laparoscopic surgery(group B), and open surgery(group C) respectively. The clinical data was analyzed through statistical software SPSS22.0. The surgically-related indexes and immunological function indexes were expressed as ■. The three-sample comparison was compared by one-way analysis of variance, the two-sample comparison was compared by the independent t\\test, and the total clinical efficacy and postoperative complication rates were compared by a four-cell table χ~2 test. The difference was statistically significant when P<0.05. Results The operation time in group A was longer than those in group B and group C(all P<0.05). The blood loss and postoperative drainage in group A were higher than those in group B and group C(all P<0.05); The hospitalization time in group A and B were shorter than that in group C(P<0.05). The total effective rates in group A, B, and C were 95.7%, 90.9%, and 76.1% respectively. The total effective rate in group A and group B were higher than that in group C(P<0.05). The complication rates in group A, B, and C were 6.5%, 8.7%, and 32.6% respectively, the difference among the three groups was statistically significant(P<0.05), among them, the incidence of complications in A and B groups were lower than those in group C, the differences were statisticallysignificant( all P < 0. 05). After the operation,the NK cell levels in group A and B were lower than that in group C( P < 0. 05). The levels of CD3+,CD4+in group A and B were significantly higher than those in group C( P < 0. 05),so patients in group A had minimal immunosuppression after surgical traumatic stress.Conclusion Areola laparoscopy and small incision laparoscopy have good surgical results,laparoscopy were better than the areola laparoscopy in operation time,intraoperative blood loss and intraoperative drainage of small incision,the incidence of postoperative complications is low in the two surgical methods,however,areola laparoscopy has less immunosuppressive effect on patients,both surgical results are superior than open surgery and worthy of popularization and application.
引文
[1] French JD,Haugen BR.Thyroid-Specific T Cells in Patients With Differentiated Thyroid Cancer: Implications for Immune-Based Therapies?[J].J Clin Endocrinol Metab,2017,102(7):2131-2132.
[2] 仉志军,杨兴旺,杨春晓,等.腹腔镜下改良淋巴结清扫术在甲状腺癌中的应用价值[J/CD].中华普外科手术学杂志:电子版,2016,10(3):228-230.
[3] Hao G.Effects comparison of laparoscopic assisted small incision thyroidectomy and open surgery on patients with thyroid tumor[J]. Clinical Medicine,2018,38(1):3-4.
[4] 薛会朝,王雷,程少华,等.经乳晕入路完全腔镜甲状腺手术的操作技巧与体会[J].腹腔镜外科杂志,2017,22(4):256-261.
[5] Ehlers M,Kuebart A,Hautzel H,et al.Epitope-specific antitumor immunity suppresses tumor spread in papillary thyroid cancer[J].J Clin Endocrinol Metab,2017,102(7):2154-2161.
[6] 徐友标,江友辉,孟云,等.不同手术式治疗甲状腺癌的临床疗效分析[J/CD]. 中华普外科手术学杂志:电子版,2016,10(5):393-395.
[7] Braun C,Kisser U,Huber A,et al.Bystander cricothyroidotomy with household devices-A fresh cadaveric feasibility study[J].Resuscitation, 2017,110:37-41.
[8] 王勇,王玲.甲状腺微小乳头状癌中央区淋巴结转移的临床分析[J/CD].中华普外科手术学杂志:电子版,2016,10(5):390-392.
[9] Luo Y,Qiu YE,Mu YF,et al.Plastic wound protectors decreased surgical site infections following laparoscopic-assisted colectomy for colorectal cancer: A retrospective cohort study[J].Medicine,2017,96(37):e7752.
[10] Wang LY,Nixon IJ,Patel SG,et al.Operative management of locally advanced,differentiated thyroid cancer[J].Surgery,2016,160(3):738\746.
[11] 宋延冰,姚中杨.乳晕入路全腔镜下甲状腺癌根治术与小切口甲状腺癌根治术的临床对比分析[J].腹腔镜外科杂志,2016,21(11):804-806.
[12] Ahn HS,Kim HJ,Kim KH,et al.Thyroid cancer screening in South Korea increases detection of papillary cancers with no impact on other subtypes or thyroid cancer mortality[J].Thyroid,2016,26(11):1535-1540.
[13] Jr J K. When and How to "Open" in Laparoscopic or Robotic Surgery[J]. Obesity Surgery, 2016, 26(4):891.
[14] 高新宝,贾高磊,田志龙,等.全乳晕入路与胸乳入路腔镜手术治疗甲状腺微灶癌的临床比较[J].中国普通外科杂志,2016,25(11):1550-1556.
[15] Sharma A,Jasim S,Reading CC,et al.Clinical Presentation and Diagnostic Challenges of Thyroid Lymphoma - A Cohort Study[J].Thyroid, 2016,26(8):1061-1067.
[16] 乐飞,游小龙,陈雯,等.小切口腔镜辅助甲状腺切除术治疗分化型甲状腺癌的疗效观察[J].实用癌症杂志,2018,33(2):227-229.
[2] 仉志军,杨兴旺,杨春晓,等.腹腔镜下改良淋巴结清扫术在甲状腺癌中的应用价值[J/CD].中华普外科手术学杂志:电子版,2016,10(3):228-230.
[3] Hao G.Effects comparison of laparoscopic assisted small incision thyroidectomy and open surgery on patients with thyroid tumor[J]. Clinical Medicine,2018,38(1):3-4.
[4] 薛会朝,王雷,程少华,等.经乳晕入路完全腔镜甲状腺手术的操作技巧与体会[J].腹腔镜外科杂志,2017,22(4):256-261.
[5] Ehlers M,Kuebart A,Hautzel H,et al.Epitope-specific antitumor immunity suppresses tumor spread in papillary thyroid cancer[J].J Clin Endocrinol Metab,2017,102(7):2154-2161.
[6] 徐友标,江友辉,孟云,等.不同手术式治疗甲状腺癌的临床疗效分析[J/CD]. 中华普外科手术学杂志:电子版,2016,10(5):393-395.
[7] Braun C,Kisser U,Huber A,et al.Bystander cricothyroidotomy with household devices-A fresh cadaveric feasibility study[J].Resuscitation, 2017,110:37-41.
[8] 王勇,王玲.甲状腺微小乳头状癌中央区淋巴结转移的临床分析[J/CD].中华普外科手术学杂志:电子版,2016,10(5):390-392.
[9] Luo Y,Qiu YE,Mu YF,et al.Plastic wound protectors decreased surgical site infections following laparoscopic-assisted colectomy for colorectal cancer: A retrospective cohort study[J].Medicine,2017,96(37):e7752.
[10] Wang LY,Nixon IJ,Patel SG,et al.Operative management of locally advanced,differentiated thyroid cancer[J].Surgery,2016,160(3):738\746.
[11] 宋延冰,姚中杨.乳晕入路全腔镜下甲状腺癌根治术与小切口甲状腺癌根治术的临床对比分析[J].腹腔镜外科杂志,2016,21(11):804-806.
[12] Ahn HS,Kim HJ,Kim KH,et al.Thyroid cancer screening in South Korea increases detection of papillary cancers with no impact on other subtypes or thyroid cancer mortality[J].Thyroid,2016,26(11):1535-1540.
[13] Jr J K. When and How to "Open" in Laparoscopic or Robotic Surgery[J]. Obesity Surgery, 2016, 26(4):891.
[14] 高新宝,贾高磊,田志龙,等.全乳晕入路与胸乳入路腔镜手术治疗甲状腺微灶癌的临床比较[J].中国普通外科杂志,2016,25(11):1550-1556.
[15] Sharma A,Jasim S,Reading CC,et al.Clinical Presentation and Diagnostic Challenges of Thyroid Lymphoma - A Cohort Study[J].Thyroid, 2016,26(8):1061-1067.
[16] 乐飞,游小龙,陈雯,等.小切口腔镜辅助甲状腺切除术治疗分化型甲状腺癌的疗效观察[J].实用癌症杂志,2018,33(2):227-229.