摘要
目的探讨肥胖对改良小切口甲状腺癌全切术后患者的甲状旁腺功能及生活质量的影响。方法选取2019年1月至2020年6月间西宁市中医院收治的265例甲状腺癌患者,根据患者的身体质量指数(BMI)分为肥胖组和对照组。其中,BMI<28kg/m^(2)的169例患者纳入对照组,BMI≥28kg/m^(2)的96例患者例纳入肥胖组。所有患者均采用改良小切口甲状腺癌全切术治疗,对比肥胖组与对照组患者的手术时间、出血量、术后引流量、淋巴结清扫数及转移数量和住院时间等围手术期情况。同时对比患者术前、术后1d、术后7d的甲状旁腺激素(PTH)水平以及血清钙、血清磷的水平。记录两组患者术后的切口感染、声音嘶哑、喉返神经损伤、甲状旁腺功能减退和Horner综合征等并发症发生情况,并采用生活质量评价量表(SF-36)对两组患者术后6个月的生活质量进行评估。结果肥胖组患者的手术时间、术中出血量、术后引流量以及住院时间均高于对照组,差异均有统计学意义(均P<0.05)。两组患者术后第1天、术后第3天的PTH和血钙水平均降低,术后第1天的血清磷水平均降低,差异均有统计学意义(均P<0.05)。同时术后第1天肥胖组患者的PTH及血钙水平均低于对照组,差异均有统计学意义(均P<0.05)。肥胖组患者术后出现切口感染、声音嘶哑、喉返神经损伤和甲状旁腺功能减退的发生率均高于对照组患者,此外,术后6个月,肥胖组患者的躯体功能、躯体疼痛、社会功能和心理健康维度评分均低于对照组患者,差异均有统计学意义(均P<0.05)。结论肥胖会影响改良小切口甲状腺癌全切术后患者的恢复,且会增加患者的甲状旁腺功能损伤的发生率,并对患者的生活质量产生影响,术后需要密切监测患者的PTH和血钙水平,并积极预防相关并发症发生。
Objective To investigate the effect of obesity on parathyroid function and quality of life in patients undergoing modified total thyroidectomy with small incision.Methods A total of 265 patients with thyroid cancer treated at Xining Hospital of Traditional Chinese Medicine were selected from January 2019 to June 2020.Based on the body mass index(BMI)of the patients,they were divided into an obese group and a control group.Of them,96 patients with BMI≥28 kg/m^(2)were included in the obese group and 169 patients with BMI<28 kg/m^(2)were included in a control group.All patients underwent modified total thyroidectomy with small incision.The perioperative indexes were compared between the two groups including duration of operation,bleeding volume,postoperative drainage volume,the number of lymph nodes dissected,the number of metastatic lymph nodes and length of hospital stay.At the same time,the levels of parathyroid hormone(PTH),serum calcium(CA)and serum phosphorus(P)before the surgery and at 1 d and 7 d after the operation were compared.The complications such as incision infection,hoarseness,recurrent laryngeal nerve injury,hypoparathyroidism and Horner syndrome were recorded.Quality of life 6 months after operation was evaluated in the two groups using the 36-Item Short Form Health Survey(SF-36).Results The duration of operation,intraoperative bleeding,postoperative drainage and length of hospital stay were significantly higher in the obese group than in the control group(all P<0.05).The levels of PTH and serum calcium decreased at 1 d and 3 d after the operation and serum phosphorus decreased at 1 d after the operation in the two groups(all P<0.05).At the same time,the levels of PTH and serum calcium were significantly lower in the obese group than in the control group at 1 d after the operation(all P<0.05).The incidence of incision infection,hoarseness,recurrent laryngeal nerve injury and hypoparathyroidism was significantly higher in the obese group than in the control group(all P<0.05).In addition,the scores of physical function,physical pain,social function and mental health were significantly lower in the obese group than in the control group at 6 months after operation(all P<0.05).Conclusion Obesity may affect the postoperative recovery,increase the incidence of parathyroid malfunction and affect quality of life in patients undergoing modified total thyroidectomy with small incision.Therefore,it is necessary to closely monitor the PTH and serum calcium levels in this population after the operation and actively prevent related complications.
作者
吴苏宁
董维福
马秀财
WU Sun-ning;DONG Wei-fu;MA Xiu-cai(Department of General Surgery,Xining Hospital of Traditional Chinese Medicine,Xining 810000,China)
出处
《中国肿瘤临床与康复》
2021年第11期1349-1353,共5页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
甲状腺肿瘤
改良小切口全切除术
体质量指数
甲状旁腺激素
生活质量
Thyroid neoplasms
Modified complete resection with small incision
Body mass index
Parathyroid hormone
Quality of life
作者简介
吴苏宁,男,副主任医师,主要从事普外科和急救创伤专业。
