失笑散联合腔镜甲状腺切除术对甲状腺肿瘤患者术后切口积液及疼痛的研究(1)

http://www.100md.com 2019年4月1日 《世界中医药》 20197

     摘要 目的：探究失笑散联合腔镜甲状腺切除术对甲状腺肿瘤患者术后切口积液与疼痛的影响。方法：选取2016年1月至2018年2月武汉市东西湖区人民医院收治的甲状腺肿瘤患者66例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组33例，2组患者均行腔镜甲状腺手术治疗，术后对照组给予常规治疗，观察组在对照组的基础上联合失笑散治疗，连续治疗2周。术后2周及术后1个月统计2组患者临床疗效;检测并比较2组患者术后不同时间点颈部引流量、疼痛程度及血清炎性反应因子水平变化。结果：术后2周、术后1个月观察组总有效率分别为66.76%、93.94%，均显著高于对照组的36.36%、69.70%(P<0.05或P<0.01);术后1～5 d 2组患者颈部引流量，VAS评分及血清CRP、IL-6水平均逐渐降低，且术后3、5 d观察组显著低于对照组(P<0.01)。结论：失笑散联合腔镜甲状腺切除术可有效缓解甲状腺肿瘤患者术后疼痛，减轻术后炎性反应进而减少术口引流量，临床疗效优于术后常规治疗。

    关键词 甲状腺肿瘤;腔镜甲状腺切除术;失笑散;切口积液;疼痛

    Abstract Objective：To explore the effects of Shixiao Powder combined with endoscopic thyroidectomy on the postoperative incision effusion and pain of patients with thyroid tumors.Methods：A total of 66 patients with thyroid tumors in People′s Hospital of Dongxihu District from January 2016 to February 2018 were selected and divided randomly into a control group and an observation group according to random number table，with 33 cases in each group.The 2 groups were treated with endoscopic thyroidectomy.The control group was treated with regular treatment post-operation，and the observation group was treated with Shixiao Powder on the basis of the control group post-operation.They were treated for 2 weeks continuously.The clinical efficacy in 2 groups was statisticsed in 2 weeks and 1 month post-operation; the changes of neck drainage，pain degree and serum inflammatory factors at different time′s operation in 2 groups were detected and compared.Results：The total effective rates of the observation group in 2 weeks，1 month post-operation were 66.76%，93.94% respectively，which were significantly higher than 36.36%，69.70% of the control group(P<0.05 or P<0.01); The neck drainage，VAS scores and serum CRP，IL-6 levels of patients in the 2 groups at 1 to 5 d post-operation decreased gradually，and the observation group was significantly lower than the control group at 3，5 d post-operation(P<0.01).Conclusion：Shixiao Powder combined with endoscopic thyroidectomy can effectively ease the postoperative pain of patients with thyroid tumors，relieve the postoperative inflammatory reaction and then reduce surgical discharge.The clinical efficacy is better than routine postoperative treatment.

    Key Words Thyroid tumors; Endoscopic thyroidectomy; Shixiao Powder; Incision effusion; Pain

    中圖分类号：R273 文献标识码：A doi：10.3969/j.issn.1673-7202.2019.07.045

    甲状腺肿瘤是目前临床上一种比较常见的疾病，且以青中年女性患者较为多见。手术切除对甲状腺肿瘤患者具有立竿见影的效果，尤其是目前发展起来的腔镜甲状腺切除术，其具有微创、美容等优势，倍受女性患者的青睐。但由于颈部解剖结构复杂，虽然腔镜甲状腺切除术术口小且隐蔽，但为达到美容效果，其往往被设计在双侧乳晕、胸骨等部位，导致术口与实际手术部位分离，需大面积皮下分离才能到达手术部位，加之目前腔镜技术水平有限，因此患者术后术口积液、出血、疼痛、瘀斑、感染等并发症仍比较多见，且常规止血、镇痛及对症治疗效果并不理想[1-2]。中医学将各种金刃外伤或跌扑损伤均归属于“金伤”范畴，且辨证为血瘀证，研究[3]报道，失笑散具有典型的活血化瘀、散结止痛功效，但其在甲状腺肿瘤患者术后的应用尚不多见，本研究旨在探究失笑散联合腔镜甲状腺切除术对患者术后切口积液及疼痛的影响。现将结果报道如下。(刘铮 储定改 余丽娟)

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