A comparative study of three surgical resection methods in patients with thyroid tumor
-
摘要: 目的 探讨治疗甲状腺疾病的合理术式。 方法 回顾性分析129例行手术治疗的甲状腺瘤患者的资料,按不同术式分为A组(甲状腺瘤切除术, n=58)、B组(单侧甲状腺大部分切除术, n=40)、C组(双侧甲状腺次全切除术, n=31),比较3组的手术情况(手术时间、术中出血量、术后24 h引流量、住院时间)、手术前后甲状旁腺功能［血钙(Ca2+)、甲状旁腺激素(iPTH)］变化,评定患者术后不同时间切口疼痛程度,统计手术并发症发生率及随访1年复发率。 结果 3组手术时间、术中出血量、术后24 h引流量、术后住院时间比较,差异有统计学意义(P<0.05), 由低至高依次为A组、B组、C组; 术后, 3组iPTH、Ca水平均降低,且B组、C组iPTH、Ca2+水平低于A组, C组水平低于B组,差异均有统计学意义(P<0.05); 术后不同时点, VAS评分由低至高依次为A组、B组、C组,组间差异均有统计学意义(P<0.05); 3组低血钙、甲状腺功能异常及总并发症发生率比较,差异均有统计学意义(P<0.05), 发生率由低至高依次为A组、B组、C组; A组复发率高于B组、C组,但3组复发率差异无统计学意义(P>0.05)。 结论 3种术式中,甲状腺瘤切除术创伤最小,疼痛程度低,术后恢复快,对甲状旁腺功能影响小,并发症少,但术后复发率相对较高,而单侧甲状腺大部切除术根治效果好,并发症与双侧甲状腺次全切除术比较相对较少,复发风险低。
-
关键词:
- 甲状腺瘤切除术 /
- 单侧甲状腺大部分切除术 /
- 双侧甲状腺次切除术 /
- 并发症 /
- 甲状旁腺功能
Abstract: Objective To explore reasonable surgery in the treatment of thyroid diseases. Methods A retrospective analysis was performed on data of 129 patients with thyroid tumors underwent surgery, and the patients were divided into group A(thyroidectomy, n=58), group B(unilateral total thyroidectomy, n=40)and group C(bilateral subtotal thyroidectomy, n=31). The surgery conditions(operative time, intraoperative blood loss, drainage volume at 24 h after surgery, hospital stay)and parathyroid function before and after surgery ［blood calcium(Ca2+), parathyroid hormone(iPTH)］ were compared among the three groups, and the incision pain degrees were evaluated at different time points after surgery. The incidence rate of surgical complications and the recurrence rate during 1-year follow-up were compared. Results There were significant differences among the three groups in the operative time, intraoperative blood loss, drainage volume at 24 h after surgery and postoperative hospital stay(P<0.05), with the highest in group C and lowest in group A. The levels of iPTH and Ca2+ after surgery were decreased in the three groups(P<0.05), and the indexes in groups B and C were lower than those in group A, and the group C was lower than the group B(P<0.05). The Visual Analogue Scale(VAS)scores at different time points after surgery in the three groups showed that it was the lowest in the group A and the highest in group C(P<0.05). There were significant differences in the incidence rates of hypocalcemia, thyroid dysfunction and total incidence rate of complications among the three groups(P<0.05), and the incidence rates from low to high were as follows: group A, group B, and group C(P<0.05). The recurrence rate of group A was higher than that of group B and group C, but there was no statistically significant difference among - the three groups(P>0.05). Conclusion Among the three surgical procedures, thyroidectomy has the lowest trauma, lower pain level, quicker postoperative recovery, smaller impacts on parathyroid function, less complications but higher postoperative recurrence rate. Unilateral total thyroidectomy has better resection effects, relatively less incidence of complications, and lower risk of recurrence. -
-
Fuller C W, Nguyen S A, Lohia S, et al. Radiofrequency ablation for treatment of benign thyroid nodules: systematic review[J]. Laryngoscope, 2014, 124(1): 346-353.
马珊, 尹乐平. 甲状腺乳头状癌手术方式的选择[J]. 实用医院临床杂志, 2017, 14(3): 124-127. 沈叶, 陶利华, 单远洲. 甲状腺腺叶切除治疗单侧甲状腺肿块82例疗效观察[J]. 安徽医药, 2018, 22(6): 1091-1095. 邓燕青, 张春芳, 李晓丹, 等. 视觉模拟版IPSS评分表的应用评价[J]. 中华泌尿外科杂志, 2011, 32(10): 691-694. Ito Y, Fujii K, Murase T, et al. Striated duct adenoma presenting with intra-tumoral hematoma and papillary thyroid carcinoma-like histology[J]. Pathol Int, 2017, 67(6): 316-321.
周大新, 周丽, 黄健康. 分化型甲状腺癌两种手术方式的临床分析[J]. 安徽医药, 2016, 20(5): 961-962. Wang F, Wang Y G, Wang L, et al. Strong association of high urinary iodine with thyroid nodule and papillary thyroid cancer[J]. Tumour Biol, 2014, 35(11): 11375-11379.
Wei W J, Wang Y L, Li D S, et al. Association study of single nucleotide polymorphisms in mature microRNAs and the risk of thyroid tumor in a Chinese population[J]. Endocrine, 2015, 49(2): 436-444.
宋琦, 李晓明. 甲状腺手术中甲状旁腺和喉神经功能损伤的防治策略[J]. 中国肿瘤临床, 2017, 44(9): 409-414. Zhang Y, Zhong Q, Chen X H, et al. Diagnostic value of microRNAs in discriminating malignant thyroid nodules from benign ones on fine-needle aspiration samples[J]. Tumour Biol, 2014, 35(9): 9343-9353.
王朝晖, 全昌银. 经乳晕腔镜手术在甲状腺良性肿瘤中的应用[J]. 实用临床医药杂志, 2016, 20(1): 62-64. 王新征, 侯永强, 王明军, 等. 改良小切口术式与传统术式治疗甲状腺良性肿瘤疗效分析[J]. 实用医院临床杂志, 2018, 15(4): 43-46. Sawicka-Gutaj N, Waligórska-Stachura J, Andrusiewicz M, et al. Nicotinamide phosphorybosiltransferase overexpression in thyroid malignancies and its correlation with tumor stage and with survivin/survivin DEx3 expression[J]. Tumour Biol, 2015, 36(10): 7859-7863.
郭欣, 吴志宇, 陈春悠. 临床颈淋巴结阴性甲状腺乳头状癌不同手术方式的疗效比较[J]. 中国肿瘤临床, 2016, 43(9): 366-370. 李圆, 杨方亮. 甲状旁腺原位显露和保护技术在全甲状腺切除术中的应用[J]. 实用临床医药杂志, 2016, 20(3): 108-109. 刘琛, 邹卫, 韩世星, 等. 患侧全切术与对侧行甲状腺大部切除术治疗复发性甲状腺结节良性肿瘤对患者甲状腺功能的影响[J]. 解放军预防医学杂志, 2019, 37(3): 90-91 , 94.
计量
- 文章访问数: 370
- HTML全文浏览量: 103
- PDF下载量: 10
下载:
苏公网安备 32100302010246号