Abstract: 【Abstract】 Objective To evaluate the response to trauma in primary hyperthyroidism patients who underwent endoscopic thyroidectomy via breast approach. Methods Fifty?three patients with prima?ry hyperthyroidism patients，admitted from Oct 2015 to Oct 2016 and underwent bilateral subtotal thy?roidectomy，were assigned endoscopic thyroidectomy via breast approach group（ET，n=18），and con?ventional open thyroidectomy group （COT，n=35）. The responses to trauma were measured, including Hs?CRP，TNF?α and IL?6 in peripheral blood at 2 hours pre?operation and 24 hours post?operation. The systemic inflammatory response syndrome（SIRS）was assessed in two groups. Results The postopera?tive values of Hs?CRP，TNF?α and IL?6 were higher than preoperative values in ET group, as same as in COT group. However，the changes（△Hs?CRP，△TNF?α and △IL?6）before and after operation in two groups were no significant difference（P>0.05）. And the morbidity of post?operation SIRS was approxi?mate within the two different surgery ways （P>0.05）. Conclusion Both the endoscopic thyroidectomy and conventional open thyroidectomy caused patients trauma?associated inflammatory response. But there was no significant difference of the trauma effect between ET group and COT group. It is optional surgery for appropriate patients.

Key words: primary hyperthyroidism, thyroidectomy, endoscopic surgery, trauma effect

摘要： 【摘要】目的 分析原发性甲亢患者术后的创伤反应变化。方法 资料来源于2015年10月~2016年10月确诊为原发性甲亢行手术治疗的病例,其中18例经胸乳入路腔镜下双侧甲状腺次全切除（ET组），35例行传统开放切口的双侧甲状腺次全切除术（COT组）。测定术前2 h和术后24 h创伤反应指标：血超敏C反应蛋白（Hs?CRP）、肿瘤坏死因子α（TNF?α）和白介素6（IL?6），术后72 h内评估是否合并发全身炎症反应综合症（SIRS），比较两组3个应激指标及术后合并SIRS的例数。结果 腔镜经胸乳入路组手术时间较开放组长,而术后住院天数少于对照组，两组术中出血量、术后引流量无显著性差异。两组均无严重副损伤和并发症。两种术式术后24 h血Hs?CRP、TNF?α、IL?6水平均较术前明显升高（P<0.001）。但两组3个创伤反应指标的变化值△Hs?CRP、△TNF?α和△IL?6比较，差异无统计学意义（P>0.05）。两组术后并发SIRS例数无显著性差异（P>0.05）。结论 与传统开放手术相比，完全腔镜甲状腺切除术治疗原发性甲亢手术时间较传统开放组长,术后住院时间缩短,安全性类似,引起机体的创伤反应无显著性差异，对于合适的病例可选择应用。

关键词: 原发性甲亢, 腔镜, 创伤反应 , 双侧甲状腺次全切除