双侧结节性甲状腺肿手术方式的探讨  

Total thyroidectomy for bilateral multinodular goiter

作　　者：邵堂雷[1] 杨卫平[1] 丁家增[1] 金筱泰[1] 陈拥军[1] 严佶祺[1] 李勤裕[1] 马迪[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普外科,上海200025

出　　处：《中华普通外科杂志》2008年第12期939-942,共4页Chinese Journal of General Surgery

摘　　要：目的探讨双侧甲状腺全切除／近全切除术治疗双侧结节性甲状腺肿是否安全可行。方法2003年1月至2006年12月311例拟诊双侧结节性甲状腺肿者分为A、B两组；A组130例行双甲全／近全切术；B组181例行双甲次全切或／和大部切除术。结果A、B两组各有6例和2例术中冰冻报告良性，但术后石蜡切片报告为乳头状癌。A组不需再手术，B组需再手术；两组术后各3例（2．42％，3／124vs．1．68％，3／179）有暂时性声嘶，差异无统计学意义（P=0．48）。术后2月A组2例有音调改变，无法发高音，喉镜示双侧声带活动好；B组1例有声嘶，喉镜示一侧声带活动减弱。两组术后各有11（8．87％，11／124）和9例（5．03％，9／179）术后48h内有低钙血症，差异无统计学意义（P=0．16）。两组无永久性甲状旁腺功能减退。B组术后2例（1．12％，2／179）因出血需再手术。A组术后无结节性甲状腺肿复发，B组12例复发（6．70％，12／179），差异有统计学意义（P=0．02）。结论双甲全／近全切除术可减少结节性甲状腺肿术后复发率和再手术率，且并发症并无增加，是安全可行的。Objective To evaluate the safety and rationality of total/near total bilateral thyroideetomy（TBT） for patients with bilateral multinodular goiter（BMG）. Methods From January 2003 to December 2006,311 BMG eases were preoperatively divided into two groups, 130 cases in group A underwent TBT, and 181 cases in group B were treated with subtotal/partial bilateral thyroideetomy. Results There were 6 and 2 cases in group A and group B respectively diagnosed by intraoperative frozen biopsy as BMG, but identified as papillary carcinoma by final pathology. Hence the 6 eases in group A avoided reoperation, while the 2 cases in group B underwent a resection of the remnant gland. Transient hoarseness developed in 3 （2. 42%, 3/124） and 3 （1.68%, 3/179） cases in group A and group B respectively （ P = 0. 48 ）. Transient bypocalcemia developed in 11 （ 8.87%, 11/124 ） and 9 （ 5. 03% ,9/179 ） cases in group A and group B respectively（ P =0. 16）. There was no postoperative goiter recurrence in group A, but recurrence developed in 12 cases （6. 70%, 12/179） in group B（P =0. 02）. Conclusions Total bilateral thyroidectomy is safe and rational for the management of bilateral thyroid goiter.

关 键 词：甲状腺肿 结节性 甲状腺切除术 手术后并发症 复发 

分 类 号：R686[医药卫生—骨科学]