ABSTRACT
Objective:To investigate the effect of inflation-free thyroid surgery on patient-specific immune function and inflammatory response.Methods:Sixty patients who underwent axillary endoscopic thyroid surgery at the First Affiliated Hospital of Bengbu Medical College from January 2021 to May 2023 were selected and randomly divided into an observation group and a control group using a random number table method, with 30 patients in each group. The control group underwent unilateral lobectomy and isthmus resection under transareola carbon dioxide inflation endoscopy, while the observation group underwent unilateral lobectomy and isthmus resection under transareola non inflation endoscopy. Compare the cellular immune related indicators, humoral immune related indicators, inflammatory response related indicators, as well as arterial blood partial pressure of carbon dioxide (PaCO 2) and end-expiratory carbon dioxide (PetCO 2) levels at T 1, T 2, and T 3 time points before anesthesia induction (T 1), during adenoidectomy (T 2), at the end of surgery (T 3), on the first postoperative day (T 4), and on the second postoperative day (T 5) in two groups of patients. The measurement data is represented by xˉ±s, and independent sample t-test is used for comparison between the two groups; The comparison between two groups at multiple time points was conducted using two factor analysis of variance, and the pairwise comparison was conducted using LSD- t test; Counting data is represented as an example (%), and inter group comparisons are made using χ 2 Inspection. Results:At time point T 1, there was no statistically significant difference between the two groups of patients in terms of cellular immune related indicators, humoral immune related indicators, and inflammatory response related indicators (all P>0.05). At time points T 2, T 3, T 4, and T 5, the CD3 +, CD4 +, CD4 +/CD8 + values and serum IgA, immunoglobulin A, immunoglobulin IgM The levels of immunoglobulin IgG were all lower than the T 1 time point in this group [control group: (31.49±5.37)%, (26.76±6.11)%, (34.75±5.99)%, (38.92±5.37)%, (51.78±5.90)%, (25.37±8.23)%, (19.12±7.13)%, (29.15±9.85)%, (33.49±8.03)%, (40.12±6.05)%, (0.97±0.28), (0.71±0.30), (1.11±0.36), (1.21±0.39)%, (1.69±0.41), (0.95±0.13), (0.91±0.14) (0.82±0.13), (0.96±0.16) g/L vs (1.21±0.20) g/L, (7.74±1.26), (7.33±1.31), (7.16±1.28), (7.82±1.31) g/L vs (9.18±1.52) g/L, (0.87±0.14), (0.86±0.13), (0.73±0.16), (0.88±0.15) g/L vs (1.16±0.22) g/L; Observation group: (35.82±5.71)%, (30.85±5.86)%, (39.43±5.68)%, (42.53±5.64)% vs (51.36±6.28)%, (30.39±9.76)%, (23.34±8.64)%, (34.68±11.37)%, (38.92±9.82)% vs (40.75±5.68)%, (1.15±0.35a), (0.89±0.38), (1.31±0.33), (1.52±0.37) vs (1.63±0.35), (1.04±0.17), (0.98±0.17) 0), (0.91±0.11a) (1.07±0.14) g/L vs (1.24±0.18) g/L, (8.51±1.35), (8.07±1.32), (7.93±1.34), (8.56±1.39) g/L vs (9.12±1.47) g/L, (0.95±0.11), (0.93±0.12), (0.83±0.18), (0.97±0.14) g/L vs (1.19±0.21) g/L], The CD8+values of both groups of patients were higher than those of the T 1 time point in this group, and at the T 4 time point, the control group was higher than the observation group [(29.89±8.99)% vs (25.70±6.91)%], with statistically significant differences (both P<0.05). At time points T 2, T 3, T 4, and T 5, both groups of patients had serum IL-interleukin-1 levels β、Interleukin IL-6, TNF tumor necrosis factor α The levels of CRP and CRPC reactive protein were higher than those at T 1 time point in this group [control group: (3.92±1.80), (4.16±1.86), (5.81±2.14), (4.46±1.87) ng/L vs (1.36±0.61) ng/L, (5.76±2.78), (6.68±3.12), (9.73±3.12), (4.65±2.78) ng/L vs (0.92±0.60) ng/L, (1.02±0.42), (1.30±0.61), (7.82±2.28), (6.65±2.16) mg/L vs (0.57±0.16) mg/L, (4.48±2.04) (4.48±2.04), (6.45±2.52), (5.33±2.15) ng/L vs (2.86±1.03) ng/L; Observation group: (3.04±1.09), (3.29±1.14), (4.56±2.01), (3.52±1.34) ng/L vs (1.65±0.63) ng/L, (4.12±2.11), (5.07±2.98), (8.07±3.15), (3.22±2.69) ng/L vs (0.98±0.53) ng/L, (0.81±0.34), (1.00±0.50), (6.65±2.03), (5.43±1.93) mg/L vs (0.56±0.12) mg/L, (3.39±1.81), (3.89±1.81) 4±1.93), (5.11±2.10) (3.96±2.03) ng/L vs (2.91±1.09) ng/L], and the control group was higher than the observation group, with statistically significant differences (all P<0.05). At time point T 1, there was no statistically significant difference in PaCO 2 and PetCO 2 between the two groups of patients (both P>0.05); At time points T 2 and T 3, the levels of PaCO 2 [(44.1±4.1), (45.8±4.0) mmHg] and PetCO 2 [(40.8±4.0), (42.1±3.5) mmHg] in the control group were higher than those at time points T 1 [(38.4±1.8), (36.3±1.9) mmHg] and observation group [PaCO 2: (38.3±2.0), (38.6±2.6) mmHg; PetCO 2: (36.3±1.9), (36.5±2.9) mmHg] (all P<0.05), There was no statistically significant difference between the observation group and this group at T 1 time point (all P>0.05). Conclusions:Inflation-free lumpectomy thyroid surgery is worthwhile as it has less suppressive effect on specific immunity and causes less inflammatory response compared to inflatable lumpectomy thyroid surgery.
ABSTRACT
Objective To study the safety and availability of extended resection,gland reconstruction and mammary gland lavage in treatment of mammary duct expansion.Methods 41 patients with duct expansion admitted from Mar.2012 to Jan.2015 were studied and they were randomly divided into two groups.15 patients in the control group received normal surgical treatment,and 26 patients in the observation group received extended resection,gland reconstruction and mammary gland lavage treatment.Results The operation time,intraoperatve blood loss,length of hospital stay and degree of satisfaction of the observation group were superior to those of the control group while the recurrence rate was lower than that of control group.The gland expanded resection reduced the recurrence rate,the shape of the breast was improved,and the continuous irrigation was the guarantee for the immediate formation of the gland.The three kinds of surgical procedures were organically combined and complement each other.Conclusion The surgical methord of extended resection,gland reconstruction and mammary gland lavage is worth of further exploring due to its advantages of easy to operate,good cosmetic effect and low recurrence rate.