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传统开放性甲状腺手术创伤明显,影响术后美观,病人的接受度不高[1]。腔镜甲状腺手术可降低创伤,利于恢复,已被广泛应用[2-3],并且已经相对成熟,但不少学者对腔镜甲状腺手术给机体带来的应激创伤方面存在质疑。此外,临床中缺少甲状腺手术对于机体的应激创伤因子相关方面的研究,没有充分的理论依据。白细胞(WBC)、血糖(Glu)、C反应蛋白(CRP)以及促肾上腺皮质激素(ACTH)作为机体应激反应的相关因子,可以一定程度上反映机体的创伤程度。本研究通过动态检测以上创伤因子的水平变化,探讨不同甲状腺手术方式对于病人身体应激的影响。
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3组术前WBC、CRP、Glu、ACTH水平及术后3 d Glu水平差异均无统计学意义(P>0.05);3组术后1、3 d WBC、CRP、Glu、ACTH水平均高于术前(P < 0.05);3组术后1 d WBC、CRP、Glu、ACTH水平均高于术后3 d(P < 0.05);术后1、3 d,常规组、腋窝组、胸乳组WBC、CRP、ACTH水平逐渐降低(P < 0.01)(见表 1)。
分组 n 术前 术后1 d 术后3 d F P MS组内 WBC 常规组 30 5.39±1.48 11.01±2.63▲ 8.59±1.71▲■ 59.45 < 0.011 4.010 腋窝组 32 5.59±1.38 9.71±1.83*▲ 7.59±1.38*▲■ 56.93 < 0.011 2.386 胸乳组 28 5.71±1.79 8.18±1.42*#▲ 6.51±1.39*#▲■ 21.32 < 0.011 2.384 F — 0.32 14.07 13.91 — — — P — >0.05 < 0.011 < 0.011 — — — MS组内 — 2.403 4.125 2.253 — — — CRP 常规组 30 2.81±0.69 24.87±6.77▲ 18.13±6.79▲■ 124.46 < 0.011 30.804 腋窝组 32 2.61±0.76 18.91±5.81*▲ 13.75±5.19*▲■ 108.74 < 0.011 20.423 胸乳组 28 2.69±0.68 15.01±4.67*#▲ 9.53±4.11*#▲■ 81.72 < 0.011 13.054 F — 0.61 21.10 17.75 — — — P — >0.05 < 0.011 < 0.011 — — — MS组内 — 0.508 34.074 30.208 — — — Glu 常规组 30 4.69±0.61 5.99±0.55*▲ 5.11±0.49▲■ 43.31 < 0.011 0.305 腋窝组 32 4.89±0.54 5.51±0.49*▲ 5.07±0.48■ 12.82 < 0.011 0.254 胸乳组 28 4.79±0.62 5.59±0.63*▲ 5.10±0.47▲■ 13.64 < 0.01 0.334 F — 0.89 6.48 0.06 — — — P — >0.05 < 0.01 >0.05 — — — MS组内 — 0.347 0.310 0.231 — — — ACTH 常规组 30 24.01±8.96 68.01±16.11▲ 45.45±16.57▲■ 70.92 < 0.01 204.793 腋窝组 32 23.12±8.87 57.12±16.87*▲ 35.87±13.87*▲■ 50.97 < 0.01 185.217 胸乳组 28 22.23±7.29 45.13±15.97*#▲ 26.88±9.39*#▲■ 31.05 < 0.01 132.119 F — 0.32 14.20 13.34 — — — P — >0.05 < 0.01 < 0.01 — — — MS组内 — 71.288 267.069 187.434 — — — q检验:与常规组比较*P < 0.05;与腋窝组比较#P < 0.05;与术前比较▲P < 0.05;与术后1 d比较■P < 0.05 表 1 3组WBC、CRP、Glu和ACTH水平比较(x±s,n;×105/L)
不同甲状腺手术方式对机体应激的影响
Effects of different thyroid surgery methods on body stress
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摘要:
目的探讨胸乳入路、腋窝入路腔镜甲状腺手术以及常规开放甲状腺手术对机体应激创伤的影响。 方法选取行甲状腺手术的病人90例,根据自愿选择手术方式分为胸乳组28例、腋窝组32例和常规组30例。比较3组病人术前、术后1、3 d的白细胞(WBC)、血糖(Glu)、C反应蛋白(CRP)和促肾上腺皮质激素(ACTH)水平。 结果3组术前WBC、CRP、Glu、ACTH水平及术后3 d Glu水平差异均无统计学意义(P>0.05);3组术后1、3 d WBC、CRP、Glu、ACTH水平均高于术前(P < 0.05);3组术后1 d WBC、CRP、Glu、ACTH水平均高于术后3 d(P < 0.05);术后1、3 d,常规组、腋窝组、胸乳组WBC、CRP、ACTH水平逐渐降低(P < 0.01)。 结论腔镜甲状腺手术对机体应激的影响低于开放甲状腺手术。 Abstract:ObjectiveTo investigate the effects of endoscopic thyroid surgery via thoraco mammary approach approach, axillary approach and conventional open thyroid surgery on stress trauma. MethodsNinety patients undergoing thyroid surgery were divided into in the thoraco mammary group(n=28), axillary group(n=32) and conventional group(n=30).The levels of white blood cell(WBC), blood glucose(Glu), C reactive protein(CRP) and adreno-cortico-tropic-hormone(ACTH) in the three groups were compared before operation, 1 day and 3 days after operation. ResultsThere was no significant difference in the levels of WBC, CRP, Glu, ACTH before operation, and Glu at 3 days after operation among the three groups(P>0.05).The levels of WBC, CRP, Glu and ACTH in the three groups at 1 day and 3 days after operation were higher than those before operation(P < 0.05).The levels of WBC, CRP, Glu and ACTH in the three groups at 1 day after operation were higher than those at 3 days after operation(P < 0.05).At 1 day and 3 days after operation, the levels of WBC, CRP and ACTH gradually decreased in the conventional group, axillary group and thoraco mammary group(P < 0.01). ConclusionsThe endoscopic thyroid surgery has lower effects on stress than open thyroid surgery. -
Key words:
- thyroid neoplasms /
- thyroid surgery /
- endoscopy /
- stress
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表 1 3组WBC、CRP、Glu和ACTH水平比较(x±s,n;×105/L)
分组 n 术前 术后1 d 术后3 d F P MS组内 WBC 常规组 30 5.39±1.48 11.01±2.63▲ 8.59±1.71▲■ 59.45 < 0.011 4.010 腋窝组 32 5.59±1.38 9.71±1.83*▲ 7.59±1.38*▲■ 56.93 < 0.011 2.386 胸乳组 28 5.71±1.79 8.18±1.42*#▲ 6.51±1.39*#▲■ 21.32 < 0.011 2.384 F — 0.32 14.07 13.91 — — — P — >0.05 < 0.011 < 0.011 — — — MS组内 — 2.403 4.125 2.253 — — — CRP 常规组 30 2.81±0.69 24.87±6.77▲ 18.13±6.79▲■ 124.46 < 0.011 30.804 腋窝组 32 2.61±0.76 18.91±5.81*▲ 13.75±5.19*▲■ 108.74 < 0.011 20.423 胸乳组 28 2.69±0.68 15.01±4.67*#▲ 9.53±4.11*#▲■ 81.72 < 0.011 13.054 F — 0.61 21.10 17.75 — — — P — >0.05 < 0.011 < 0.011 — — — MS组内 — 0.508 34.074 30.208 — — — Glu 常规组 30 4.69±0.61 5.99±0.55*▲ 5.11±0.49▲■ 43.31 < 0.011 0.305 腋窝组 32 4.89±0.54 5.51±0.49*▲ 5.07±0.48■ 12.82 < 0.011 0.254 胸乳组 28 4.79±0.62 5.59±0.63*▲ 5.10±0.47▲■ 13.64 < 0.01 0.334 F — 0.89 6.48 0.06 — — — P — >0.05 < 0.01 >0.05 — — — MS组内 — 0.347 0.310 0.231 — — — ACTH 常规组 30 24.01±8.96 68.01±16.11▲ 45.45±16.57▲■ 70.92 < 0.01 204.793 腋窝组 32 23.12±8.87 57.12±16.87*▲ 35.87±13.87*▲■ 50.97 < 0.01 185.217 胸乳组 28 22.23±7.29 45.13±15.97*#▲ 26.88±9.39*#▲■ 31.05 < 0.01 132.119 F — 0.32 14.20 13.34 — — — P — >0.05 < 0.01 < 0.01 — — — MS组内 — 71.288 267.069 187.434 — — — q检验:与常规组比较*P < 0.05;与腋窝组比较#P < 0.05;与术前比较▲P < 0.05;与术后1 d比较■P < 0.05 -
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