| 刘晓君,张洋,郝培培,等.微波消融术与颈部侧切口手术对甲状腺良性结节病人疗效及美容效果的影响[J].安徽医药,2023,27(10):1999-2003. |
| 微波消融术与颈部侧切口手术对甲状腺良性结节病人疗效及美容效果的影响 |
| Influence of microwave ablation and lateral neck incision surgery on the curative effect and cosmetic effect of patients with benign thyroid nodules |
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| DOI：10.3969/j.issn.1009-6469.2023.10.020 |
| 中文关键词: 甲状腺结节 微波消融术 颈部侧切口 甲状腺激素 喉返神经功能 创伤程度 |
| 英文关键词: Thyroid nodule Microwave ablation Lateral neck incision Thyroid hormones Recurrent laryngeal nerve function Degree of trauma |
| 基金项目:河北省医学科学研究计划项目( 20200432) |
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| 中文摘要: |
| 目的研究对比微波消融术与颈部侧切口手术在甲状腺良性结节中效果、安全性。方法选取 2018年 6月至 2020年 6月华北医疗健康集团峰峰总医院甲状腺良性结节病人 117例，依据治疗术式不同分为消融组( 59例)、切除组( 58例)。切除组行颈部侧切口切除术，消融组行超声引导下微波消融术。比较两组手术有关指标情况、并发症以及手术前后创伤程度定量指标［超敏 -C反应蛋白( hs-CRP)、肿瘤坏死因子 -α(TNF-α)、肾上腺素( E)、去甲肾上腺素( NE)］术前、术后 1个月、 12个月甲状腺激素水平［促甲状腺激素( TSH)、游离甲状腺素( FT4)、游离三碘甲腺原氨酸( FT3)］、观测者瘢痕评价量表( OSAS)、病人瘢痕自我评分量表( PSAS)、温哥华瘢痕量表( VSS)评分。结果消融组手术时间( 32.75±10.48)min、住院时间( 2.06±0.35)d短于切除组［( 67.03±14.29)min、(5.93±1.42)d］术中出血量( 9.53±1.61)mL、住院费用( 3.91±0.32)千元低于切除组［( 34.12±6.50)mL、(5.57±0.53)千元］(P<0.05)；与术前比较，组术后 6h、24 h血清 hs-CRP、TNF-α、E、NE水平均增高，但消融组较切除组低( P<0.05)；消融组术后 1个月、 12个月血清 TSH水平及术后 6个月、 12个月 OSAS、PSAS、VSS评分低于切除组，术后 1个月、 12个月血清 FT4、FT3水平高于切除组( P<0.05)；消融组术后 12个月总有效率 94.92%低于切除组 98.27%(P>0.05)。结论与颈部侧切口手术相比，微波消融术治疗甲状腺良性结节病人保证疗效的同时，在降低手术创伤、促进术后恢复、减少术后并发症、提升美容效果方面均具有一定优势，且对甲状腺激素、喉返神经功能影响小。 |
| 英文摘要: |
| Objective To compare the efficacy and safety of microwave ablation and cervical lateral incision surgery in benign thyroid nodules.Methods A total of 117 patients with benign thyroid nodules in Fengfeng General Hospital of North China Medical and HealthGroup from June 2018 to June 2020 were selected and assigned into ablation group (n=59) and resection group (n=58) according to different treatment procedures. The resection group underwent neck side incision resection, and the ablation group underwent ultrasound-guided microwave ablation. The surgery related indicators, complications and quantitative indicators of preoperative and postoperative traumaseverity [high-sensitivity-C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) ,epinephrine (E), norepinephrine (NE)] Thyroidhormone levels before, 1 month, and 12 months after surgery [thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine protosine (FT3)], observer scar assessment scale (OSAS), patient scar self-score scale (PSAS), vancouver scar scale (VSS) score at 6 months and 12 months after surgery of the two groups were compared.Results The operation time (32.75±10.48) min and hospital stay(2.06±0.35) d in the ablation group were shorter than those in the resection group [(67.03±14.29)min, (5.93±1.42)d], and the intraoperative blood loss (9.53±1.61) mL and hospitalization costs (3.91±0.32) thousand yuan were lower than those in the resection group [(34.12±6.50) mL, (5.57±0.53)thousand yuan] (P<0.05). Compared with the preoperative period, the serum levels of hs-CRP, TNF-α, E,and NE at 6 h and 24 h after surgery were increased in the two groups, but the ablation group was lower than the resection group (P<0.05). The serumTSH levels at 1 and 12 months after surgery and OSAS, PSAS, and VSS scores at 6 and 12 months after surgery in the ablation group werelower than those in the resection group, and serum FT4 and FT3 levels were higher than those in the resection group at 1 month and 12months after operation (P<0.05). There was no statistically significant difference in the total effective rate between the ablation group andthe resection group at 12 months after surgery, which was 94.92% and 98.27%, respectively (P>0.05).Conclusion Compared with lateral neck incision surgery, microwave ablation in the treatment of patients with benign thyroid nodules has certain advantages in reducingsurgical trauma, promoting postoperative recovery, reducing postoperative complications, and improving cosmetic effects while ensuringthe curative effect. It has little effect on thyroid hormones and recurrent laryngeal nerve function. |
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