甲状腺功能亢进合并甲状腺微小癌不同手术方式疗效评价  

Efficacy evaluation of different surgical methods for hyperthyroidism combined with thyroid microcarcinoma

作　　者：何启雄 李盛海 黄铭祥 周成茂 谢启明[1] HE Qi-xiong, LI Sheng-hai, HUANG Ming-xiang, ZHOU Cheng-mao, XIE Qi-ming(Department of General Surgery, Affiliated Hospital of Zhaoqing Medical College, Zhaoqing, Guangdong 52606)

机构地区：[1]广东省肇庆市肇庆医学高等专科学校附属医院普外科,广东肇庆526060

出　　处：《临床普外科电子杂志》2018年第1期11-14,共4页Journal of General Surgery for Clinicians(Electronic Version)

摘　　要：目的对比不同手术方式治疗原发性甲状腺功能亢进合并甲状腺微小癌(thyroid micro carcinoma, TMC)的疗效差别。方法选取2011年5月至2014年6月肇庆医学高等专科学校附属医院收治的原发性甲状腺功能亢进症合并TMC患者60例,按照随机数字表法分为观察组和对照组各30例。对照组行甲状腺双叶次全切除术治疗,观察组予以癌灶侧甲状腺全切除+峡部切除术治疗,比较两组疗效、术中及术后相关指标(手术时间、术中出血量、住院时间)及并发症发生情况,并于术后随访3年,比较两组患者术后恢复情况。结果观察组总有效率93.33%(28/30)高于对照组70.00%(21/30),差异显著(P<0.05);两组术中出血量及手术时间比较,观察组低于对照组,差异显著(P<0.05);两组并发症发生率比较,观察组6.67%低于对照组30.00%,差异显著(P<0.05);术后第1年和第3年观察组肿瘤复发率分别为3.33%、10.00%,低于对照组26.67%、33.33%,差异显著(P<0.05)。结论与甲状腺双叶次全切除术相比,癌灶侧甲状腺全切除+峡部切除术可在一定程度上提高对原发性甲状腺功能亢进症合并TMC患者的疗效,并且远期预后良好,并发症发生率低,值得临床应用推广。Objective To compare the curative effect of different surgical methods in the treatment of primary hyperthyroidism with thyroid microcarcinoma. Methods Sixty patients with primary hyperthyroidism complicated with TMC in our hospital from May 2011 to June 2014 were selected and randomly divided into observation group （n=30） and control group （n=30） according to random number table. Patients in the control group underwent double subtotal thyroidectomy, while patients in the observation group underwent total resection of cancerous sideplus isthmus. The curative effect, intraoperative and postoperative related indicators （operation time, intraoperative blood loss, hospital stay）, complication and postoperative recovery were compared, moreover patients were followed up for 3 years. Results The total effective rate in the observation group was 93.33% （28/30）, which was higher than 70.00% （21/30） in the control group （P〈0.05）; The intraoperative blood loss and operation time in the observation group were significantly lower than those in the control group （P〈0.05）; The incidence of complications in the observation group was 6.67%, which was lower than 30.00% in the control group（P〈0.05）; The tumor recurrence rates in observation group at the 1st year and the 3rd year after operation were 3.33% and 10.00% respectively, which were significantly lower than those in control group （26.67%, 33.33%; P〈0.05）. Conclusion Compared with the double subtotal thyroidectomy, the total resection of cancerous sideplus isthmus has a better efficacy and long-term prognosis for patients with primary hyperthyroidism and TMC with less complications, which is worthy of clinical promotion.

关 键 词：原发性甲状腺功能亢进症 甲状腺微小癌 癌灶侧甲状腺全切除+峡部切除术 疗效 远期随访 

分 类 号：R653[医药卫生—外科学]