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目的 :探讨超声刀(UHS)与高频电刀(HMES)对各中医分型分化型甲状腺癌(DTC)的治疗作用及复发率的比较。方法 :选取择期行手术治疗的DTC患者64例,根据DTC中医分型与病理分型分层随机法,分为HMES组与UHS组,每组32例。HMES组予超声刀手术治疗,UHS组予高频电刀手术治疗。详细记录手术相关指标及并发症,比较近期疗效,随访并记录复发情况。结果 :手术相关指标上,较HMES组,UHS组手术时间、切口长度显著较短(P<0.01),术中出血量较少(P<0.01),术后引流量无差异(P>0.05);在手术并发症上,较HMES组,UHS组短暂性甲状旁腺功能低下发生率较低(P<0.05),短暂性喉返神经损伤发生率无差异(P>0.05);在近期疗效上,HMES组治疗有效率为90.63%,UHS组治疗有效率为96.88%,经秩和检验无差异(Z=-0.899,P=0.369>0.05);复发率上,HMES组复发率为40.63%(13/32),UHS组复发率为34.38%(11/32),经卡方检验无统计学意义(χ2=0.267,P=0.606>0.05)。中医证型上来看,肝郁痰阻型22例,痰结血瘀型27例,心肝阴虚型15例,其发生率比较有显著统计学意义(χ2=12.548,P=0.002<0.01)。结论 :超声刀与高频电刀治疗各型DTC疗效相当,术后肝郁痰阻型DTC复发率较高,单纯手术效果较差。
Objective: To investigate the therapeutic effect and relapse rate of UHS and HMES on different types of differentiated thyroid cancer (DTC) in Chinese medicine. Methods: Sixty-four patients with DTC undergoing elective surgery were divided into HMES group and UHS group according to DTC TCM classification and pathological classification and stratification randomization, with 32 cases in each group. HMES group was treated by ultrasonic knife, UHS group was treated by high frequency electric knife. Detailed records of surgery-related indicators and complications, the more recent efficacy, follow-up and record the recurrence. Results: Compared with HMES group and UHS group, the operative time and incision length were significantly shorter (P <0.01), less blood loss during operation (P <0.01) and no difference in postoperative drainage volume (P> 0.05) The incidence of transient hypoparathyroidism was lower (P <0.05) and the incidence of transient recurrent laryngeal nerve injury was no significant difference (P> 0.05) between the HMES group and the UHS group in surgical complications. In the short term, , The effective rate of HMES group was 90.63%, the effective rate of UHS group was 96.88%, there was no difference by rank sum test (Z = -0.899, P = 0.369> 0.05); The relapse rate of HMES group was 40.63% 13/32). The recurrence rate in UHS group was 34.38% (11/32). There was no significant difference between the two groups (χ2 = 0.267, P = 0.606> 0.05). TCM syndromes, 22 cases of phlegm blocking liver, sputum stasis type 27 cases, heart and liver yin deficiency type 15 cases, the incidence was statistically significant (χ2 = 12.548, P = 0.002 <0.01). Conclusion: Ultrasound scalpel and high frequency electrosurgical treatment of various types of DTC has the same effect, postoperative liver depression and phlegm blocking type DTC recurrence rate is higher, the simple operation results are poor.