改良甲状腺切除术治疗甲亢的疗效及对TSH、T3、T4的影响

摘要

Objective To explore the effects of modified thyroidectomy in the treatment of hyperthyroidism and impacts on thyroid stimulating hormone (TSH),T3 and T4.Methods The data of 114 patients with hyperthyroidism to receive treatment in our hospital were analyzed retrospectively and the patients were divided into a conventional group and a modified group according to different operation methods.The conventional group was treated with conventional thyroidectomy and the modified group with modified thyroidectomy.The intraoperative amount of bleeding,operation time,length of stay (LOS),effects,postoperative complications,and the changes in the levels of tumor necrosis factor-α (TNF-α),TSH,T3 and T4 before and after the operation between the two groups were observed and compared.Results The operation time and length of stay in the modified group were shorter than those in the conventional group and the intraoperative amount of bleeding was less than that in the conventional group (P ＜ 0.05).After the treatment,the overall response rate(ORR) in the modified group was 92.98％,which was significantly higher than the 78.95％ (P ＜ 0.05) in the conventional group.The post-treatment TNF-α,T3 and T4 levels in the two groups were lower than those before the treatment,while the TSH levels were higher than those before the treatment (P ＜ 0.05) and the variation in the modified group was greater than that in the conventional group (P ＜ 0.05).The incidence of postoperative complications was lower than that in the conventional group (P ＜ 0.05).Conclusion The modified thyroidectomy has obvious effects in the treatment of hyperthyroidism and can shorten the operation time,improve thyroid function and lower TNF-α levels and the incidence of postoperative complications.%目的 探讨改良甲状腺切除术治疗甲状腺功能亢进症的疗效及对促甲状腺激素(TSH)、甲状腺原氨酸(T3)、甲状腺素(T4)的影响.方法 回顾性分析医院收治的甲亢患者114例的病例资料,根据手术方法不同分为常规组和改良组.常规组给予常规甲状腺次全切除术治疗,改良组给予改良式甲状腺次全切除术治疗.观察比较两组术中出血量、手术时间、住院时间、治疗效果及术后并发症情况,以及手术前后血清肿瘤坏死因子-α(TNF-α)、TSH、T3及T4水平的变化.结果 改良组手术时间和住院时间较常规组短,术中出血量较常规组少(P＜0.05).治疗后,改良组总有效率为92.98％,显著高于常规组的78.95％(P＜0.05).治疗后,两组TNF-α、T3及T4水平均较治疗前下降,TSH水平较治疗前上升(P＜0.05),且改良组的变化幅度大于常规组(P＜0.05).改良组术后并发症发生率低于常规组(P＜0.05).结论 改良甲状腺切除术治疗甲亢效果明显,可缩短手术时间,改善甲状腺功能,降低TNF-α水平和术后并发症发生率.