摘要
目的探讨3D腔镜下改良小切口甲状腺全切术治疗分化型甲状腺癌(DTC)的效果及对炎症创伤指标的影响。方法选取南充市中心医院2018年7月至2020年9月收治的80例DTC患者,按照随机数字表法分为对照组和研究组,各40例。对照组给予改良小切口甲状腺全切术,研究组给予3D腔镜下改良Miccoli手术。比较两组手术效果、手术情况、炎症创伤指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)]、甲状腺功能指标[三碘甲状腺原氨酸(T3)、甲状腺激素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)]、循环肿瘤细胞(CTC)、肿瘤标志物[甲状腺球蛋白(Tg)、肿瘤特异性生长因子(TSGF)、血管内皮生长因子(VEGF)]、并发症发生率及术后1年复发率。结果研究组手术时间短于对照组,术中出血量少于对照组(P<0.05);两组组内术前及术后第1、3天血清CRP、IL-6水平呈先升高后下降趋势,T3、T4、FT3、FT4水平(P<0.05);两组组间术前血清CRP、IL-6、T3、T4、FT3、FT4水平差异无统计学意义(P>0.05);研究组术后第1、3天血清CRP、IL-6、T3、T4、FT3、FT4水平低于对照组(P<0.05);两组组内术后第1天CTC、血清Tg、VEGF、TSGF水平低于术前、术后第1天(P<0.05);两组组间术前、术后第3天CTC、血清Tg、VEGF、TSGF水平差异无统计学意义(P>0.05);研究组并发症发生率低于对照组(P<0.05);两组治疗总有效率、术后1年复发率差异无统计学意义(P>0.05)。结论3D腔镜下改良小切口甲状腺全切术治疗DTC能优化手术情况,减轻炎症创伤程度,减少并发症,且对机体甲状腺功能影响小,不增加复发风险。
Objective To investigate the effect of modified small incision total thyroidectomy under 3D endoscopy on differentiated thyroid cancer(DTC)and its impact on inflammatory trauma indicators.Methods Eighty DTC patients admitted to Nanchong Central Hospital from July 2018 to September 2020 were selected and divided into a control group and a study group of 40 cases each according to the random number table method.The control group was given modified small-incision total thyroidectomy,and the study group was given modified Miccoli surgery under 3D lumenscopy.The two groups were compared in terms of surgical results,surgical conditions,inflammatory trauma indexes[C-reactive protein(CRP),interleukin-6(IL-6)],thyroid function indexes[triiodothyronine(T3),thyroid hormone(T4),free triiodothyronine(FT3),free thyroid hormone(FT4)],circulating tumor cells(CTC),tumor markers[thyroid globulin(Tg),tumor-specific growth factor(TSGF),vascular endothelial growth factor(VEGF)],complication rate and 1-year postoperative recurrence rate.Results The operation duration in the study group was shorter than that in the control group,and the intraoperative blood loss was less than that in the control group(P<0.05).Both groups exhibited an upward trend followed by a downward trend in serum levels of CRP and IL-6 before surgery and on the first and third days after surgery(P<0.05).There were no statistically significant differences in preoperative serum levels of CRP,IL-6,T3,T4,FT3,and FT4 between the two groups(P>0.05).Postoperatively,serum levels of CRP,IL-6,T3,T4,FT3,and FT4 were lower in the study group on the first and third days after surgery compared to the control group(P<0.05).Within both groups,postoperative levels of CTC,serum Tg,VEGF,and TSGF on the first day were lower than those before surgery and on the first day after surgery(P<0.05).There were no statistically significant differences in preoperative and postoperative levels of CTC,serum Tg,VEGF,and TSGF between the two groups on the third day after surgery(P>0.05).The incidence of complications in the study group was lower than that in the control group(P<0.05).There were no statistically significant differences in total treatment efficacy and recurrence rate one year postoperatively between the two groups(P>0.05).Conclusion The modified minimal incision thyroidectomy under 3D endoscopy for the treatment of DTC can optimize the surgical conditions,reduce the degree of inflammatory trauma,reduce complications,and have minimal impact on the body’s thyroid function without increasing the risk of recurrence.
作者
尹均明
YIN Junming(Department of Thyroid and Mammary Vascular Surgery,Nanchong Central Hospital,Nanchong 637000,China)
出处
《安徽医学》
2024年第11期1362-1367,共6页
Anhui Medical Journal
基金
2023年南充市社会科学研究“十四五”规划项目(编号:NC23B011)。
关键词
3D腔镜
改良小切口甲状腺全切术
分化型甲状腺癌
肿瘤标志物
预后
3D lumpectomy
Modified small incision total thyroidectomy
Differentiated thyroid cancer
Tumor markers
Prognosis
