传统术式与低领小弧形切口对甲状腺外科手术的应用效果比较
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摘要
目的分析甲状腺外科手术中传统术式与低领小弧形切口的应用效果,探讨治疗该病的有效术式。方法选取武汉市普仁医院2017年10月到2018年10月收治的86例甲状腺外科手术患者,分为传统组和微创组,各43例,传统组应用传统术式治疗,微创组应用低领小弧形切口治疗,对比两组患者的术中情况(手术时间、出血量、切口长度)、术后情况(疼痛程度、住院时间)、甲状旁腺素和血清钙水平、并发症发生情况(切口皮下结节、切口粘连、低钙血症、甲状腺功能减退、喉返神经损伤)、切口美观程度。结果微创组患者的手术时间、术中出血量以及切口长度均少于传统组,且术后疼痛程度评分与住院时间均小于传统组,差异均有统计学意义(t=18.963、15.843、3.350、18.943、3.443,均P<0.05);两组患者术后的甲状旁腺素和血清钙水平均较术前有所降低,但微创组降低幅度小于传统组,差异有统计学意义(t=4.310、13.160,P<0.05);微创组患者的并发症发生率(9.3%)显著低于传统组(27.8%)(χ~2=4.914,P<0.05);微创组患者切口美观程度优于传统组(χ~2=12.797,P=0.002)。结论甲状腺外科手术中低领小弧形切口的应用效果显著,具有手术时间短、出血量少、切口长度小、术后疼痛轻、住院时间短、并发症少等优势,且对甲状旁腺素和血清钙水平的影响较小,术后美观程度高,值得临床推行。
Objective To compare the effect of traditional operation and small arc incision with low collar in thyroidectomy, and to explore the effective operation for this disease. Methods Eightysix patients with thyroid surgery admitted to Puren Hospital of Wuhan City from October 2017 to October2018 were divided into traditional group and minimally invasive group, with 43 cases in each group. The traditional group was treated by traditional operation, while the minimally invasive group by low-collar small arc incision. The two groups were compared in intraoperative conditions(operation time, bleeding volume,incision), incision length, postoperative condition(degree of pain, length of hospital stay), parathyroid hormone and serum calcium level, complications(incision subcutaneous nodules, incision adhesion,hypocalcemia, hypothyroidism, recurrent laryngeal nerve injury), and incision aesthetic level. Results The operation time, bleeding volume and incision length of the minimally invasive group were less than those of the traditional group, and the pain score and hospitalization time of the minimally invasive group were smaller than those of the traditional group(t=18.963, 15.843, 3.350, 18.943, 3.443, all P<0.05). The levels of parathyroid hormone and serum calcium in the two groups were lower than those before operation, but the minimally invasive group decreased less(t=4.310、13.160; both P<0.05). The incidence of complications in the minimally invasive group(9.3%) was lower than that in the traditional group(27.8%) and the difference was significant(χ~2=4.914, P<0.05); the aesthetic degree of incision in the minimally invasive group was better than that in the traditional group(χ~2=12.797, P=0.002). Conclusions The application effect of low collar small arc incision in thyroidectomy is remarkable, which has the advantages of shorter operation time, less bleeding, smaller incision length, slighter postoperative pain, shorter hospitalization time and fewer complications. It also has less influence on parathyroid hormone and serum calcium levels, good postoperation course, and worthy of clinical implementation.
Objective To compare the effect of traditional operation and small arc incision with low collar in thyroidectomy, and to explore the effective operation for this disease. Methods Eightysix patients with thyroid surgery admitted to Puren Hospital of Wuhan City from October 2017 to October2018 were divided into traditional group and minimally invasive group, with 43 cases in each group. The traditional group was treated by traditional operation, while the minimally invasive group by low-collar small arc incision. The two groups were compared in intraoperative conditions(operation time, bleeding volume,incision), incision length, postoperative condition(degree of pain, length of hospital stay), parathyroid hormone and serum calcium level, complications(incision subcutaneous nodules, incision adhesion,hypocalcemia, hypothyroidism, recurrent laryngeal nerve injury), and incision aesthetic level. Results The operation time, bleeding volume and incision length of the minimally invasive group were less than those of the traditional group, and the pain score and hospitalization time of the minimally invasive group were smaller than those of the traditional group(t=18.963, 15.843, 3.350, 18.943, 3.443, all P<0.05). The levels of parathyroid hormone and serum calcium in the two groups were lower than those before operation, but the minimally invasive group decreased less(t=4.310、13.160; both P<0.05). The incidence of complications in the minimally invasive group(9.3%) was lower than that in the traditional group(27.8%) and the difference was significant(χ~2=4.914, P<0.05); the aesthetic degree of incision in the minimally invasive group was better than that in the traditional group(χ~2=12.797, P=0.002). Conclusions The application effect of low collar small arc incision in thyroidectomy is remarkable, which has the advantages of shorter operation time, less bleeding, smaller incision length, slighter postoperative pain, shorter hospitalization time and fewer complications. It also has less influence on parathyroid hormone and serum calcium levels, good postoperation course, and worthy of clinical implementation.
引文
[1]范晓峰,李晓东,周冬.低位弧形切口法与“L”型切口法在甲状腺癌合并颈部淋巴结转移患者手术中的应用[J].医学临床研究, 2016, 33(5):916-918.
[2]白鹏.胸骨上小切口甲状腺切除术治疗甲状腺结节的效果及并发症分析[J].中国继续医学教育, 2016, 8(17):111-113.
[3]高峰,吴迟.传统甲状腺切除术与改良小切口甲状腺切除术治疗甲状腺结节的临床疗效比较[J].标记免疫分析与临床, 2016, 23(5):514-516, 561.
[4]沈佼.护理干预对甲状腺腺瘤手术患者心理、生理应激反应及术后疼痛的影响研究[J].中国医疗设备, 2017, 32(12):225-226.
[5]刘凯,闵翔,张思林,等.低领弧形切口功能性颈廓清术治疗甲状腺癌临床研究[J].中国耳鼻咽喉颅底外科杂志, 2017,23(6):546-549.
[6]吴贤江,戴磊,王耀宗.腔镜下甲状腺肿瘤切除术的临床应用[J].中国临床保健杂志, 2017, 20(2):197-198.
[7]杜海燕,刘美快,黄督平,等. B超联合促甲状腺素与甲状腺球蛋白比值检查诊断甲状腺结节良恶性价值分析[J].中国临床保健杂志, 2018, 21(5):692-695.
[8]由田,胡友主.完全乳晕入路腔镜甲状腺手术后并发症的研究进展[J].腹腔镜外科杂志, 2017, 22(4):308-312.
[9]贾琦.改良低领小切口用于甲状腺腺瘤治疗的疗效分析[J].贵州医药, 2018, 42(5):80-81.
[10]宋先旭,姜宏春,李宏海,等.超低位颈前小切口手术治疗甲状腺腺瘤临床分析[J].中国现代普通外科进展, 2018, 21(4):275-276.
[11]刘晓敏,杨小军,高芳宁,等.长低位弧形切口保留颈丛神经的择区性颈淋巴结清扫术在分化型甲状腺癌术中的应用价值[J].武警后勤学院学报(医学版), 2016, 26(5):359-362.
[12]路晶,颜璟,吴艳军,等.微波消融术与传统开放手术治疗甲状腺良性结节对机体应激反应的比较[J/CD].中华普通外科学文献(电子版), 2017, 11(3):183-186.
[13]乔雷,董朝,马斌林.研究低位弧形切口在甲状腺乳头状癌颈部淋巴结转移患者术中的效果[J].世界最新医学信息文摘,2018, 10(13):194-195.
[14]解孝章.甲状腺乳头状癌低位领式切口择区性保留颈丛颈淋巴结清扫术的临床研究[J/CD].中华普通外科学文献(电子版),2018, 12(1):56-58.
[15]谷彬,钱军,张荧荧,等.超声刀辅助下低领小切口甲状腺手术的临床分析[J].大连医科大学学报, 2016, 38(6):562-564.
[16]王继卫.超低位颈前小切口甲状腺腺瘤切除术的临床疗效探讨[J].湖北科技学院学报(医学版), 2017, 31(3):214-215.
[17]郭凯,王卓颖,李端树,等.低位弧形切口用于甲状腺癌功能性颈部淋巴结清扫术价值研究[J].中国实用外科杂志, 2015,35(8):867-869.
[18]王子璋,梁秦龙,冯海波,等.腔镜辅助下甲状腺手术治疗体会[J].现代肿瘤医学, 2016, 24(19):3039-3041.
[19]包晓都,张筱骅,李忠朋,等. Focus超声刀在甲状腺手术中对甲状旁腺功能的保护作用评价[J].中国普通外科杂志,2015, 24(9):1295-1298.
[2]白鹏.胸骨上小切口甲状腺切除术治疗甲状腺结节的效果及并发症分析[J].中国继续医学教育, 2016, 8(17):111-113.
[3]高峰,吴迟.传统甲状腺切除术与改良小切口甲状腺切除术治疗甲状腺结节的临床疗效比较[J].标记免疫分析与临床, 2016, 23(5):514-516, 561.
[4]沈佼.护理干预对甲状腺腺瘤手术患者心理、生理应激反应及术后疼痛的影响研究[J].中国医疗设备, 2017, 32(12):225-226.
[5]刘凯,闵翔,张思林,等.低领弧形切口功能性颈廓清术治疗甲状腺癌临床研究[J].中国耳鼻咽喉颅底外科杂志, 2017,23(6):546-549.
[6]吴贤江,戴磊,王耀宗.腔镜下甲状腺肿瘤切除术的临床应用[J].中国临床保健杂志, 2017, 20(2):197-198.
[7]杜海燕,刘美快,黄督平,等. B超联合促甲状腺素与甲状腺球蛋白比值检查诊断甲状腺结节良恶性价值分析[J].中国临床保健杂志, 2018, 21(5):692-695.
[8]由田,胡友主.完全乳晕入路腔镜甲状腺手术后并发症的研究进展[J].腹腔镜外科杂志, 2017, 22(4):308-312.
[9]贾琦.改良低领小切口用于甲状腺腺瘤治疗的疗效分析[J].贵州医药, 2018, 42(5):80-81.
[10]宋先旭,姜宏春,李宏海,等.超低位颈前小切口手术治疗甲状腺腺瘤临床分析[J].中国现代普通外科进展, 2018, 21(4):275-276.
[11]刘晓敏,杨小军,高芳宁,等.长低位弧形切口保留颈丛神经的择区性颈淋巴结清扫术在分化型甲状腺癌术中的应用价值[J].武警后勤学院学报(医学版), 2016, 26(5):359-362.
[12]路晶,颜璟,吴艳军,等.微波消融术与传统开放手术治疗甲状腺良性结节对机体应激反应的比较[J/CD].中华普通外科学文献(电子版), 2017, 11(3):183-186.
[13]乔雷,董朝,马斌林.研究低位弧形切口在甲状腺乳头状癌颈部淋巴结转移患者术中的效果[J].世界最新医学信息文摘,2018, 10(13):194-195.
[14]解孝章.甲状腺乳头状癌低位领式切口择区性保留颈丛颈淋巴结清扫术的临床研究[J/CD].中华普通外科学文献(电子版),2018, 12(1):56-58.
[15]谷彬,钱军,张荧荧,等.超声刀辅助下低领小切口甲状腺手术的临床分析[J].大连医科大学学报, 2016, 38(6):562-564.
[16]王继卫.超低位颈前小切口甲状腺腺瘤切除术的临床疗效探讨[J].湖北科技学院学报(医学版), 2017, 31(3):214-215.
[17]郭凯,王卓颖,李端树,等.低位弧形切口用于甲状腺癌功能性颈部淋巴结清扫术价值研究[J].中国实用外科杂志, 2015,35(8):867-869.
[18]王子璋,梁秦龙,冯海波,等.腔镜辅助下甲状腺手术治疗体会[J].现代肿瘤医学, 2016, 24(19):3039-3041.
[19]包晓都,张筱骅,李忠朋,等. Focus超声刀在甲状腺手术中对甲状旁腺功能的保护作用评价[J].中国普通外科杂志,2015, 24(9):1295-1298.