甲状腺肿物合并甲状腺功能亢进症患者的术前用药及手术治疗  

Experience in premedication and surgical treatment of patients with thyroid mass and hyperthyroidism

作　　者：王超宇[1] 袁平[1] 余招焱[1] WANG Chaoyu;YUAN Ping;YU Zhaoyan(Department of Vascular and Thyroid Surgery,Guizhou Provincial People's Hospital/Guizhou University People's Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院/贵州大学人民医院血管甲状腺外科,贵州贵阳550002

出　　处：《中国普通外科杂志》2021年第11期1350-1358,共9页China Journal of General Surgery

基　　金：贵州省科技计划基金资助项目(黔科合基础[2020]1Y290);贵州省卫健委基金资助项目(gzwjkj2018-1-033)。

摘　　要：背景与目的甲状腺肿物合并甲状腺功能亢进症(TMCWH)是甲状腺外科疾病中处理较为棘手的一种情况。传统的观点认为原发性甲状腺功能亢进症(甲亢)患者的外科手术一般需要采用卢戈氏液进行术前准备,但随着甲状腺外科手术技术的进步及甲亢手术方式的转变,这种观念也受到了一定的质疑和挑战。因此,本研究探讨术前准备中不采用卢戈氏液的TMCWH患者行手术治疗的临床效果与安全性。方法回顾性分析2018年1月—2021年1月连续收治的51例TMCWH患者的临床病例资料,对患者的一般临床资料、甲亢治疗药物使用的种类及剂量、甲状腺功能的变化情况、手术方式、术后并发症发生情况等进行总结。结果全组女36例,男15例;年龄30~77岁;病程时间6个月至22年;术前均存在不同程度的甲状腺毒症。49例患者采用甲巯咪唑及普萘洛尔联合用药进行术前准备,13例患者同时口服泼尼松药物治疗;另2例患者术前仅使用普萘洛尔及泼尼松作术前准备。2例患者术前行甲状腺动脉介入栓塞治疗。全组患者采用联合口服药物治疗的术前准备时间为5~10 d;术前32例患者甲状腺功能未完全恢复至正常,但全组患者术前基础代谢率(BMR)均下降明显,维持在9%~15%,心率在71~85次/min。40例行全甲状腺切除,6例行单侧腺叶切除+对侧腺叶近全或次全切除,单侧腺叶切除5例,术后患者恢复均较顺利,无1例发生甲状腺危象。术后门诊随访,未见甲亢或癌肿复发。结论TMCWH患者采用常规药物进行术前准备,将T3/FT3和(或)T4/FT4控制在超过上限10%以内,BMR控制在20%以下即可手术。对于促甲状腺激素受体抗体明显升高的TMCWH患者,采用全甲状腺切除或近全切除有助于彻底治愈疾病。Background and Aims Thyroid mass complicated with hyperthyroidism(TMCWH)is a difficult situation in thyroid surgery.The traditional concept is that patients with primary hyperthyroidism undergoing surgery generally require the use of Lugol's solution for preoperative preparation.However,with the advancement of thyroid surgical techniques and the change of operation methods,this concept has also been questioned and challenged.Therefore,this study was conducted to investigate the clinical effect and safety of performing surgery in TMCWH patients without addition of Lugol's solution in preoperative preparation.Methods The clinical data of 51 consecutive patients with TMCWH admitted from January 2018 to January 2021 were retrospectively analyzed.The general clinical data of the patients,types and doses of anti-thyroid drugs,changes in thyroid function and operation methods as well as the incidence of postoperative complications were summarized.Results There were 36 females and 15 males in the whole group,aged from 30 to 77 years old,with a disease course of 6 months to 22 years and varying degrees of thyrotoxicosis.Forty-nine patients received the combination treatment of methimazole and propranolol for preoperative preparation,of whom,13 patients were treated with prednisone at the same time;the other two patients only used propranolol and prednisone for preoperative preparation.Two patients underwent thyroid artery embolization before operation.The preoperative preparation time of the whole group was 5-10 d;the preoperative thyroid function of 32 patients did not fully return to normal,but the basal metabolic rate(BMR)of all patients decreased significantly,and maintained at 9%to 15%,and the heart rate was 71 to 85 bpm.Total thyroidectomy was performed in 40 cases,6 cases underwent unilateral lobectomy plus subtotal or subtotal resection of contralateral lobes,and 5 cases were subjected to unilateral lobectomy.All patients recovered uneventfully after the operation,and no thyroid crisis occurred.In postoperative ou

关 键 词：甲状腺肿 甲状腺功能亢进症 术前用药法 甲状腺切除术 

分 类 号：R653.2[医药卫生—外科学]