甲状腺全切术与次全切除术治疗双侧多发性甲状腺结节的临床效果研究  

Clinical Effect of Total Thyroidectomy and Subtotal Thyroidectomy in the Treatment of Bilateral Multiple Thyroid Nodules

作　　者：林春冬 李志民[1] 谢锦居 LIN Chundong;LI Zhimin;XIE Jinju(Xinglin Branch of the First Affiliated Hospital of Xiamen University,Xiamen 361022,China;不详)

机构地区：[1]厦门大学附属第一医院杏林分院,福建厦门361022

出　　处：《中外医学研究》2021年第33期13-16,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:分析甲状腺全切术(total thyroidectomy,TT)与甲状腺次全切除术(subtotal thyroidectomy,ST)治疗双侧多发性甲状腺结节的临床效果。方法:回顾性分析本院2018年7月-2019年6月收治103例行手术切除的双侧多发性甲状腺结节患者的病历及随访资料,其中行ST手术55例(ST组),TT手术48例(TT组),比较两组相关指标、术后并发症发生率与甲状腺结节复发率。结果:ST组手术切口长度(5.3±0.7)cm、手术时间(68.5±16.4)min,均短于TT组的(6.2±0.6)cm、(81.7±23.8)min (P<0.05);ST组术中出血量(68.4±8.5)ml,少于TT组的(75.6±10.2)ml (P<0.05);TT组甲状旁腺显露比例为93.8%,显著高于ST组的80.0% (P<0.05);两组术后病理检查结果比较差异无统计学意义(P>0.05)。TT组术后暂时性甲状旁腺功能低下发生率为18.8%,高于ST组的5.5%(P<0.05),两组术后暂时性喉返神经损伤、永久性喉返神经损伤和永久性甲状旁腺功能低下发生率比较差异均无统计学意义(P>0.05)。ST组术后8~19个月甲状腺结节复发率(10.9%)显著高于TT组(P<0.05)。结论:TT治疗双侧多发性甲状腺结节相对复杂,术后暂时性甲状旁腺功能低下发生率高于ST,但能显著降低术后甲状腺结节复发率。Objective:To analyze the clinical effect of total thyroidectomy (TT) and subtotal thyroidectomy (ST) in the treatment of bilateral multiple thyroid nodules.Method:The medical records and follow-up data of 103 patients with bilateral multiple thyroid nodules who underwent surgical resection admitted to our hospital from July 2018 to June 2019 were retrospectively analyzed,including 55 patients who underwent ST surgery (ST group) and 48 patients who underwent TT surgery (TT group).The related indicators,incidence of postoperative complications and recurrence rate of thyroid nodules were compared between the two groups.Result:The incision length[(5.3±0.7) cm]and operation time[(68.5±16.4) min]in ST group were shorter than (6.2±0.6) cm and (81.7±23.8) min in TT group (P<0.05).The intraoperative blood loss of ST group[(68.4±8.5) ml]was less than (75.6±10.2) ml of TT group (P<0.05).The proportion of parathyroid exposure in TT group was 93.8%,which was significantly higher than 80.0% in ST group (P<0.05).There was no significant difference in postoperative pathological examination results between the two groups (P>0.05).The incidence of postoperative temporary hypoparathyroidism in the TT group was 18.8%,which was higher than 5.5% in the ST group (P<0.05),and there were no significant differences in the incidence of postoperative temporary recurrent laryngeal nerve injury,permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism between the two groups (P>0.05).The recurrence rate of thyroid nodules 8 to 19 months after surgery in ST group (10.9%) was significantly higher than that in TT group (P<0.05).Conclusion:TT therapy for bilateral multiple thyroid nodule is relatively complex,and the incidence of postoperative temporary hypoparathyroidism is higher than ST,but it can significantly reduce the recurrence rate of postoperative thyroid nodules.

关 键 词：多发性甲状腺结节 甲状腺全切术 甲状腺次全切除术 甲状旁腺功能低下 复发 

分 类 号：R653[医药卫生—外科学]