中国现代普通外科进展

目的：探讨自拟消瘀膏治疗经口腔前庭入路腔镜甲状腺术后颏下水肿的临床效果及安全性。方法：选取2022年10月—2023年12月河南中医药大学第一附属医院普外一区行经口腔前庭入路腔镜甲状腺手术的90例患者，随机分为对照组、观察组各45例，对照组予基础治疗；观察组在对照组的基础上予自拟消瘀膏颏下外敷治疗，疗程7 d。对比两组治疗前后的水肿消退度、颏下水肿评分、疼痛视觉模拟评分、美容满意度评分、炎症指标（白细胞介素-6、血清肿瘤坏死因子α、C反应蛋白）的水平，记录治疗期间两组不良反应，对比治疗后血常规、肝功能、肾功能、电解质等安全性指标。结果：与对照组相比，观察组的水肿消退度更高、美容满意度评分更高，差异有统计学意义（P<0.001）；两组术后2 d疼痛视觉模拟评分、颏下水肿评分比较，差异无统计学意义（P>0.05）；在术后4、7、15及30 d，观察组在缓解疼痛（视觉模拟评分）和减轻水肿（颏下水肿评分）方面均优于对照组，差异有统计学意义（P<0.001）；两组术后24 h白细胞介素-6、血清肿瘤坏死因子α、C反应蛋白水平比较，差异无统计学意义（P>0.05）；在术后72 h，观察组在降低炎症因子（白细胞介素-6、血清肿瘤坏死因子α、C反应蛋白）水平方面优于对照组，差异有统计学意义（P<0.05）；两组术后7 d血常规、肝功能、肾功能、电解质指标，差异无统计学意义（P>0.05）。结论：自拟消瘀膏治疗经口腔前庭入路腔镜甲状腺术后患者颏下水肿安全有效，其作用可能与其调节白细胞介素-6、血清肿瘤坏死因子α等炎症因子的水平相关。

Objective: To investigate the clinical effect and safety of self-made Xiaoyu ointment in the treatment of submental edema after transoral endoscopic thyroidectomy vestibular approach. Methods: A total of 90 patients who underwent TOETVA in the First District of General Surgery of the First Affiliated Hospital of Henan University of Chinese Medicine from October 2022 to December 2023 were randomly divided into the control group and the observation group, with 45 cases in each group. The control group was treated with basic treatment, and the observation group was treated with self-made Xiaoyu ointment under the chin on the basis of the control group, with 7 days of treatment. Before and after treatment, the edema regression degree, submental edema score, visual analogue scale(VAS) score, cosmetic satisfaction score, and the levels of inflammatory indicators(IL-6, TNF-α, CRP) were compared between the two groups. The adverse reactions during the treatment were recorded. The blood routine, liver function, renal function, electrolyte and other safety indicators were compared between the two groups after treatment. Results: Compared with the control group, the observation group showed a higher edema regression rate and higher cosmetic satisfaction score, with statistically significant differences(P<0.001). There was no statistically significant difference in the Visual Analogue Scale(VAS) score and submental edema score between the two groups at 2 days after surgery(P>0.05). At 4, 7, 15, and 30 days postoperatively, the observation group was superior to the control group in both pain relief(VAS score) and edema reduction(submental edema score), with statistically significant differences(P<0.001). No statistically significant difference was observed in the levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), and Creactive protein(CRP) between the two groups at 24 hours after surgery(P>0.05). At 72 hours postoperatively, the observation group outperformed the control group in reducing the levels of inflammatory factors(IL-6, TNF-α, CRP), with statistically significant differences(P<0.05). There were no statistically significant differences in blood routine, liver function, renal function, or electrolyte indicators between the two groups at 7 days after surgery(P>0.05). Conclusion: Self-made Xiaoyu ointment is safe and effective in the treatment of submental edema in patients after TOETVA. Its effect may be related to the regulation of inflammatory factors such as IL-6, TNF-αand CRP.