肿块局部扩大切除术治疗甲状腺单发良性病变的临床研究  

Clinical effect of extended lumpectomy in the treatment of patients with single benign thyroid disease

作　　者：许健[1] 章远江[1] 金科[1] Xu Jian;Zhang Yuanjiang;Jin Ke(Department of Breast and Thyroid Surgery,the Second People′s Hospital of Changshu,Changshu,Jiangsu 215500,China)

机构地区：[1]常熟市第二人民医院乳腺甲状腺外科,江苏省215500

出　　处：《中国基层医药》2020年第5期596-600,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨肿块局部扩大切除术治疗不同大小的甲状腺单发良性病变的临床治疗效果。方法选择常熟市第二人民医院2008年6月至2011年6月收治的甲状腺单发良性病变患者132例作为观察组,根据肿块大小分为两组:≤2 cm组(64例)、>2 cm组(68例)。另外随机选取同时期因甲状腺单发良性病变行次全切除术的病例共62例为对照组。比较各组患者切口大小、手术时间、术中出血量、术后引流量、住院天数、住院费用及术后并发症[声音嘶哑、饮水呛咳、低钙、甲状腺功能减低(甲减)、肿瘤复发]的发生情况。并分别与同时期62例因甲状腺单发良性病变行次全切除术的病例为对照组进行比较。结果≤2 cm组切口大小、手术时间、术中出血量、术后引流量、住院天数、住院费用均少于或短于对照组[(3.6±0.4)cm比(4.5±0.6)cm,(40.1±9.6)min比(76.2±15.3)min,(52.2±17.8)mL比(82.1±16.8)mL,(49.8±15.7)mL比(78.1±12.4)mL,(4.9±0.9)d比(6.1±1.2)d,(7125.2±219.4)元比(8321.2±308.1)元,t=9.935、15.917、9.690、11.205、6.363、25.161,均P<0.05]。≤2 cm组术后声音嘶哑发生率低于对照组[0.0%(0/132)比6.5%(4/62),χ^2=4.4244,P<0.05];≤2 cm组术后甲减发生率低于对照组[0.0%(0/132)比8.1%(5/62),χ^2=5.374,P<0.05];其他术后并发症包括饮水呛咳、低钙、患侧肿瘤复发的发生率与对照组差异均无统计学意义(χ^2=2.097、1.040、0.968,均P>0.05)。>2 cm组手术时间、住院费用均低于对照组[(49.6±12.7)min比(76.2±15.3)min,(7641.6±382.4)元比(8321.2±308.1)元,t=10.820、11.090,均P<0.05];切口大小、术中出血量、术后引流量、住院天数与对照组差异均无统计学意义(t=1.740、1.709、1.850、1.487,均P>0.05);术后并发症包括声音嘶哑、饮水呛咳、低钙、甲减的发生率与对照组差异均无统计学意义(χ^2=2.175、0.443、1.105、1.670,均P>0.05);随访7~10年,>2 cm组肿瘤术后复发率高于对照组[10.3%(7/68)比1.6%(1/62Objective To investigate the clinical effect of extended lumpectomy in the treatment of patients with single benign thyroid disease of different sizes.Methods From June 2008 to June 2011,132 patients with single benign thyroid lesion in the Second People′s Hospital of Changshu were selected as observation group.According to the size of the lump,132 patients with single benign thyroid disease were divided into two groups:≤2cm group(64 patients)and>2cm group(68 patients).In addition,62 patients with single benign thyroid lesion underwent subtotal thyroidectomy at the same time were randomly selected as control group.The incision size,operating time,intraoperative blood loss,postoperative drainage volume,hospital day,hospital cost and postoperative complications(hoarseness,water bucking,low calcium,hypothyroidism,tumor recurrence)of the two groups were recorded and compared with the control group.Results The incision size,operating time,intraoperative blood loss,postoperative drainage volume,hospital day,hospital cost of≤2cm group were less or shorter than those of the control group[(3.6±0.4)cm vs.(4.5±0.6)cm,(40.1±9.6)min vs.(76.2±15.3)min,(52.2±17.8)mL vs.(82.1±16.8)mL,(49.8±15.7)mL vs.(78.1±12.4)mL,(4.9±0.9)d vs.(6.1±1.2)d,(7125.2±219.4)CNY vs.(8321.2±308.1)CNY,t=9.935,15.917,9.690,11.205,6.363,25.161,all P<0.05].The incidence of postoperative hoarseness in≤2cm group was lower than that in the control group[0.0%(0/132)vs.6.5%(4/62),χ^2=4.4244,P<0.05].The incidence of postoperative hypothyroidism in≤2cm group was lower than that in the control group[0.0%(0/132)vs.8.1%(5/62),χ^2=5.374,P<0.05].The incidences of postoperative water bucking,low calcium and tumor recurrence of≤2cm group had no statistically significant differences compared with those of the control group(χ^2=2.097,1.040,0.968,all P>0.05).The operating time,hospital cost of>2cm group were less than those of the control group[(49.6±12.7)min vs.(76.2±15.3)min,(7641.6±382.4)CNY vs.(8321.2±308.1)CNY,t=10.820,11.090,all P<0.05)

关 键 词：甲状腺疾病 肿瘤 甲状腺切除术 甲状腺功能减退症 手术后并发症 

分 类 号：R65[医药卫生—外科学]