[1]于金玲,朱江帆,胡海,等.内镜辅助和胸壁入路内镜甲状腺切除术与传统甲状腺切除术的比较[J].中国微创外科杂志,2008,08(1):56-60.
　Yu Jinling,Zhu Jiangfan,Hu Hai,et al.Comparison of Endoscopicassisted, Transthoracic Endoscopic, and Conventional Techniques for Thyroidectomy[J].Chinese Journal of Minimally Invasive Surgery,2008,08(1):56-60.
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内镜辅助和胸壁入路内镜甲状腺切除术与传统甲状腺切除术的比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
08
期数:
2008年1期
页码:
56-60
栏目:
出版日期:
2008-10-22

文章信息/Info

Title:
Comparison of Endoscopicassisted, Transthoracic Endoscopic, and Conventional Techniques for Thyroidectomy
作者:
于金玲; 朱江帆; 胡海; 梁春立; 徐曼珠; 戴国清; 马颖璋
同济大学附属东方医院普外科，上海200120
Author(s):
Yu Jinling; Zhu Jiangfan;  Hu Hai;  et al.
Department of General Surgery, East Hospital of Tongji University, Shanghai 200120, China
关键词:
甲状腺切除术; 内镜; 胸壁入路
Keywords:
Thyroidectomy; Endoscopy; Transthoracic approach
分类号:
R653
文献标志码:
A
摘要:
目的比较内镜辅助及胸壁入路内镜甲状腺切除术与传统甲状腺切除术创伤程度、术后疼痛、美容效果及2种内镜术式的各自特点。方法45例甲状腺结节按入院顺序分成3组，每组15例，分别行内镜辅助甲状腺切除术（endoscopic assisted thyroidectomy，EAT）、胸壁入路内镜甲状腺切除术（transthoracic endoscopic thyroidectomy，TET）及传统甲状腺切除术（conventional thyroidectomy，CT）。检测术前及术后24、72 h 血清CRP、IL6、TNFα、T淋巴细胞亚群（CD3，CD4+，CD8+，CD4+/CD8+）水平，评估手术创伤程度，视觉模拟评分法评估术后疼痛感受，5级评价法评估术后美容满意度。结果VAS疼痛评分：术后第1、3天EAT组分别为2.2±1.7、1.1±1.1，明显轻于TET组3.6±1.4、2.2±0.7（第1天 q=3.698, P<005；第3天 q=4.824, P<0.05）和CT组 4.6±1.0、3.0±0.8（第1天 q=6.339, P<0.05；第3天 q=8.332, P<0.05）。美容满意度调查EAT、TET、CT组十分满意分别为1、10、0例；满意分别为13、5、4例；一般分别为1、0、11例，TET 组和EAT组均明显优于CT组（z=-3.386,P=0.000;z=-3.676,P=0.000），TET组最佳（z=-4.513，P= 0.000）。除CT组手术前后CD4+/CD8+有统计学差异外（F=447，P=0014），3组血清IL6、TNFα、T淋巴细胞亚群水平（CD3，CD4+，CD8+）手术前后及组间比较差异均无显著性（P>0.05），CT组术后24 h CD4+/CD8+较术前降低（q=4.076, P<0.05），术后72 h恢复接近术前水平（q=0705, P>0.05）。3组CRP水平术后24、72 h均较术前明显升高（EAT组m=21, P<0.001; m=24,P<0.001；TET组m=22,P<0.001; m=23,P<0.001；CT组m=21,P<0.001;m=24,P<0.001），但3组间比较差异无显著性（P>005）。结论 EAT组术后疼痛轻、恢复快、美容效果较好，更具微创手术特征；TET组美容效果理想，未发现TET组比CT组有更严重的创伤反应。
Abstract:
ObjectiveTo compare the degree of trauma, postoperative pain, and cosmetic outcomes of endoscopicassisted thyroidectomy (EAT), transthoracic endoscopic thyroidectomy (TET), and conventional thyroidectomy (CT), and to explore the characteristics of EAT and TET. MethodsFortyfive patients with thyroid nodules were divided into three groups (n=15 in each) to underwent EAT, TET, or CT. The plasma levels of Creactive protein(CRP), interleukin6 (IL6), tumor necrosis factoralpha (TNFα), and Tlymphocyte subgroups (CD3, CD4+, CD8+, and CD4+/CD8+) were determined before and 24 and 72 hours after the operations. The degree of operative trauma was compared after the operation. Postoperative pain and cosmetic outcomes were evaluated by visual analogue score (VAS) and 5degree evaluation respectively.ResultsThe VAS in the EAT group was 2.2±17 and 1.1±1.1 on the first and third day postoperation, which were significantly lower than those in the TET group (3.6±1.4 and 22±0.7, respectively; q=3.698, P<0.05 for the first day; and q=4.824, P<0.05 for the third day) and CT group (4.6±1.0 and 3.0±0.8 respectively; q=6.339, P<0.05 for the first day, and q=8.332, P<0.05 for the third day). The 5degree evaluation of cosmetic outcomes found that 1 patient in the EAT group, 10 in the TET group, and 0 the CT group showed very high satisfaction with the cosmetic outcomes, while 13, 5, and 4 patients in the three groups showed high satisfaction, and 1, 0, and 11 patients respectively showed moderate satisfaction. The results indicated that the EAT and TET were significantly superior to CT (Z=-3.386, P=0.000; and Z=-3.676, P=0.000; respectively) in the cosmetic results, and EAT was superior to TET (Z=-4.513，P=0.000). In the CT group, the plasma level of CD4+/CD8+ lymphocyte before the operation was significantly different from that after the operation (F=447, P=0.014). Besides, no difference was detected in the levels of IL6, TNFα, and CD3, CD4+, and CD8+ lymphocytes neither between pre and postoperation nor among the three groups (P>0.05).Compared to preoperation, the level of CD4+/CD8+ lymphocyte in the CT group was decreased at 24 hours after the operation (q=4.076, P<0.05), and recovered to the preoperative level at 72 hours (q=0.705, P>0.05). The levels of CRP determined at 24 and 72 hours postoperation were both significantly higher than that before the operation in the three groups (EAT group: m=21, P<0.001, m=24, P<0.001; TET group: m=22, P<0001; m=23, P<0.001; and CT group: m=21, P<0.001; m =24, P<0.001, respectively), however, no significant difference was detected in the CRP level among the three groups.ConclusionsBy using EAT, the patients have less postoperative pain and good cosmetic outcomes, and recover quickly. The cosmetic outcome of TET is satisfying. Moreover, the traumatic reaction in the TET group is similar to that in the CT group.

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更新日期/Last Update: 2013-10-22