腔镜经胸乳入路与腔镜辅助颈部小切口甲状腺切除术炎性反应的对比研究

目的比较腔镜经胸乳入路与腔镜辅助颈部小切口甲状腺切除术对机体炎症反应的影响。方法采用前瞻性非随机比较2012年6月～2013年10月11例腔镜经胸乳入路行腔镜甲状腺手术（腔镜胸乳入路组）和21例腔镜辅助颈部小切口甲状腺切除术（腔镜辅助颈部小切口组），分别测定术前2h和术后24h的血超敏c反应蛋白（high．sensitivityCRP，Hs—CnP）、铜蓝蛋白（ceruloplasmin，CER）和白介素6（interleukin－6，IL－6），比较3个应激指标手术前后的变化。结果2组手术时间、术中出血量、术后48h引流量、术后住院时间均无显著性差异（P〉0．05）。腔镜胸乳入路组术后24h血Hs－CRP、IL-6水平较术前明显升高（10．08±5．62）nlg／Lvs．（0．46±0．21）mg／L，t=－3．178，P=0．010；（12。86±7．55）ng／Lvs．（5．99±3．47）ng／L，t：－5．617，P=0．000]，CER术前后无显著性差异（19．45±3．35）nlg／dlVS．（20．46±2．58）mg／dl，t=－0．781，P：0．453]。腔镜辅助小切I=1组术后24h血Hs－CRP、IL－6水平显著高于术前（11．394-5．86）mg／LVS．（0．57±0．26）ms／L，t=－3．576，P=0．002；（13．10±6．02）ng／LVS．（6．32±3．25）ng／L，t=－3．802，P=0．001]，血CER术前后变化无显著性差异（19．88±3．27）mg／dlVS．（19．66±3．87）mg／dl，t=－0．494，P=0．627]。腔镜胸乳入路组与腔镜辅助小切1：3组3个指标术前后差值AHs-CRP、ACER和AlL－6差异无统计学意义中位数6．5ｍg／L（0．02～50．6mg／L）vs．中位数6．6Ins／L（0～32．5mg／L），Z=－0．020，P=0．984；中位数－0．3mg／dl（－3．2－4．7mg／d1）VS．中位数2．2mg／dl（－6．0～6．3ing／d1），Z=－1．092，P=0．275；（6．874-2．06）ng／LVS．（5．41±2．73）ng／L，t=1．553，P=0．131]。结论2种术式可引起明显的应激和创伤反应，但2种术式对机体造成的应激和炎症反应

A Comparison Study on Inflammatory Reactions Between Breast Approach Laparoscopic and Minimally Invasive Video- assisted Thyroidectomy

Objective To compare inflammatory reactions between breast approach laparoscopic and minimally invasive video-assisted thyroidectomy. Methods A prospective comparison was made between 11 cases of breast approach laparoscopic thyroidectomy （Laparoscopic Group） and 21 cases of minimally invasive video-assisted thyroidectomy （Minimally Invasive Group） from June 2012 to October 2013. Serum levels of high-sensitivity CRP （Hs-CRP） , ceruloplasmin （CER） , and IL-6 at 2 hours before surgery and 24 hours after surgery were measured and compared respectively. Results In the Laparoscopic Group： the postoperative values of Hs-CRP and IL-6 were higher than preoperative values （ 10.08 ± 5.62） mg/L vs. （0.46 ± 0.21 ） rag/L, t = - 3. 178, P = 0.010; （12.86 ±7.55） ng/L vs. （5.99 ± 3.47） ng/L, t = -5. 617, P = O. 000], but the change of CER was nonsignificant （ 19.45 ± 3.35 ） mg/dl vs. （20.46 ± 2.58 ） mg/dl, t = - 0. 781, P = 0. 453 ]. In the Minimally Invasive group： the postoperative values of Hs-CRP and IL-6 were higher than preoperative values, with statistically significant differences （ 11.39 ± 5.86） mg/L vs. （0.57 ±0.26） rag/L, t= -3.576, P=0.002; （13.10±6.02） ng/Lvs. （6.32 ±3.25） ng/L, t= -3.802, P=0.001±, but the change of CER was also nonsignificant （ 19.88 ± 3.27） mg/dl vs. （ 19.66 ± 3.87） mg/dl, t = - O. 494, P = 0. 627 ]. Changes of three values before and after operation （AHs-CRP, ACER, and AIL-6） had no significant differences between the two groups 6.5 （0.02-50.6） mg/L vs. 6.6 （0-32.5） rag/L, Z= -0.020, P=0.984; -0.3 （-3.2-4.7） mg/dl vs. 2.2 （-6.0-6.3）mg/dl, Z= -1.092, P=0.275; （6.87±2.06） ng/L vs. （5.41 ±2.73） ng/L, t=1.553, P=0. 131]. Conclusion Both breast approach laparoseopic thyroideetomy and minimally invasive video-assisted thyroidectomy can lead to obvious stress and inflammatory reactions. The extent of reactions has no significant difference between the two operations.