甲状腺次全切除术与甲状腺全切除术治疗结节性甲状腺肿的疗效对比分析

目的:研究甲状腺次全切除术与甲状腺全切除术治疗结节性甲状腺肿的临床疗效。方法:选取2011年1月至2012年12月我院收治的84例结节性甲状腺肿患者,随机分为甲状腺次全切除术组(A组)和甲状腺全切除术组(B组),比较分析两组患者围手术期指标、治疗效果及并发症发生情况。结果:A组镇痛剂使用量、手术时间、术中出血量及住院时间少于B组,差异有统计学意义(P0.05)。A组和B组有效率差异无统计学意义(P0.05),A组复发率高于B组,差异有统计学意义(P0.05)。并发症发生率A组低于B组,差异有统计学意义(P0.05)。结论:甲状腺次全切除术与甲状腺全切除术治疗结节性甲状腺肿疗效相似,甲状腺次全切除术复发率更高,但并发症发生率更低。     

甲状腺全切除术与半切除术治疗甲状腺癌的临床效果分析

目的:比较甲状腺全切除术与半切除术治疗甲状腺癌的临床效果。方法:选取我院收治的90例甲状腺癌患者,对所有患者行甲状腺全切除术或近全切除术,同时应用I131以及甲状腺激素抑制治疗作为辅助治疗,并对所有患者进行随访。结果:两组患者的术中出血量、喉返神经显露率比较差异无统计学意义(P0.05),观察组的手术切口以及手术时间均明显长于对照组(P0.01),甲状旁腺显露率高于对照组(P0.01)。两组患者暂时性、永久性喉返神经损伤,暂时性、永久性甲状旁腺功能低下发生率比较差异无统计学意义(P0.05)。复发率为13.33%(6/45),观察组无复发,两组患者术后复发率比较差异具有统计学意义(P0.05)。结论:甲状腺全切除术治疗甲状腺癌的效果优于半切除术,且能够有效降低术后复发率。     

425 例结节性甲状腺肿患者术后复发影响因素的分析

目的:探讨结节性甲状腺肿复发的影响因素。方法:分别对本院425例结节性甲状腺肿患者随访1年至8年;采用SPSS软件对复发相关因素进行单因素和多因素Logistic回归分析。结果:随访患者中有39例复发,复发率为9.18%。分析结果显示,两侧甲状腺结节数量越多,结节性甲状腺肿复发率越高(OR=2.631),双侧结节性甲状腺肿患者比单侧患者复发率高(OR=2.758),与接受正规替代治疗者相比,未接受替代治疗及接受非正规替代治疗者更易复发(OR=7.577/4.151),与单纯结节切除术相比,一侧加峡部全切、对侧部分/次全切除术术后复发率低(OR=0.209)。结论:结节性甲状腺肿患者术后复发率较高,针对上述各种影响因素,在临床上相应的治疗措施可有效预防结节性甲状腺肿的复发。     

分子生物学法分析青少年甲状腺肿物临床病理及特点

探讨青少年甲状腺肿物的临床病理学特点,甲状腺癌的复发、转移和结节性甲状腺肿复发的可能相关因素。按WHO病理分型标准和国际抗癌联盟(UICC)TNM分期标准回顾性分析青少年甲状腺肿物124例及其中部分甲状腺癌和结节性甲状腺肿的随访资料。124例甲状腺肿物患者男女比例约为1 3,甲状腺癌39例(31.5%),其中乳头状癌35例,滤泡癌3例,髓样癌1例;甲状腺腺瘤59例(47.6%),结节性甲状腺肿11例(8.9%),结节性甲状腺肿伴腺瘤7例(5.6%),甲状腺炎5例(4%),甲状舌管囊肿3例(2.4%)。本组资料显示,青少年甲状腺癌以乳头状癌为主,其复发、转移与组织学亚型为弥漫硬化型及甲状腺包膜和其外软组织受侵状态相关。虽然常见淋巴结转移、肺转移以及局部侵犯周围软组织,但患者总体预后较好。结节性甲状腺肿的复发与病变弥漫位于双叶有关,而与患者性别、年龄和是否伴有乳头样及腺瘤样增生关系不密切。     

结节性甲状腺肿合并甲状腺微小乳头状癌79例的临床分析

目的:探讨结节性甲状腺肿合并甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的临床特征及诊治方法.方法:回顾性分析79例结节性甲状腺肿合并PTMC病例的临床资料.结果:56例术前B超检查考虑PTMC可能,64例经术中冰冻病理诊断,15例经术后石蜡切片证实.55例行单侧腺叶+峡部切除,清扫同侧中央区淋巴结;全甲状腺切除9例,清扫双侧中央区淋巴结.18例单侧中央区淋巴结转移(22.8％),术后并发暂时性喉返神经麻痹5例,暂时性甲状旁腺功能减退6例,并发症发生率13.9％.结论:结节性甲状腺肿为临床常见病,术前B超检查、术中冰冻病检有利于提高伴发PTMC的诊断率,PTMC中央区淋巴结转移率高,预防性清扫中央区淋巴结是必要的.     

甲状腺全切除术与双叶切除术对甲状腺微小癌患者血清甲状腺激素水平、预后及生活质量的影响

目的:探讨甲状腺全切除术与双叶切除术对甲状腺微小癌患者血清甲状腺激素水平、预后及生活质量的影响。方法:回顾性分析2016年2月～2018年8月期间我院收治的甲状腺微小癌患者103例的临床资料,根据手术方式的不同分为A组(n=50,双叶切除术)和B组(n=53,甲状腺全切除术),比较两组围术期指标、甲状腺激素水平、生活质量、并发症及复发情况。结果:B组术中出血量少于A组,手术时间、住院时间、切口长度短于A组(P0.05)。术后3个月,两组血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平均较术前降低,且B组低于A组(P0.05)。术后12个月,两组生活质量简表(SF-36)量表各维度评分均较术前升高,且B组高于A组(P0.05)。B组并发症发生率低于A组(P0.05);两组复发率比较差异无统计学意义(P0.05)。结论:甲状腺全切除术治疗甲状腺微小癌患者的预后与双叶切除术相当,可有效改善临床指标、生活质量和甲状腺功能,同时还可减少并发症发生率。     

甲状腺术中喉返神经显露对暂时性喉返神经损伤发生率的影响

目的:探究甲状腺术中喉返神经显露对暂时性喉返神经损伤发生率的影响。方法:选择我院2016年10月-2018年10月收治的行甲状腺切除术的115例患者为研究对象,按照其入院顺序经随机数字表法分为两组,两组患者均行常规甲状腺切除术。其中,对照组58例患者未显露喉返神经;研究组57例患者常规显露喉返神经,记录并比较两组患者的手术时间、术中出血量、术后引流量、切口长度和住院时间等围术期手术指标,术后1d、4d、7d的甲状旁腺激素(PTH)水平、钙离子(Ca2+)水平,术后暂时性喉返神经损伤、术后声音嘶哑、低钙血症等并发症的发生情况。结果:研究组患者的手术时间、术中出血量、术后引流量均短于(少于)对照组(P0.05),但两组患者的切口长度和住院时间无显著性差异(P0.05);研究组患者术后1d、4d、7d的血清PTH、Ca2+水平均高于对照组(P0.05),暂时性喉返神经损伤、术后声音嘶哑、低钙血症发生率均低于对照组(P0.05)。结论:甲状腺术中喉返神经显露可有效预防暂时性喉返神经和甲状腺功能的损伤,降低术后并发症的发生率,且患者的围术期指标均显著改善。     

甲状腺球蛋白及抗体测定在结节性甲状腺肿与甲状腺癌鉴别诊断中的意义

目的:对结节性甲状腺肿患者和甲状腺癌患者术前的甲状腺球蛋白(TG)、抗甲状腺球蛋白抗体(TG-Ab)水平进行回顾性分析,并对TG、TG-Ab水平在结节性甲状腺肿、甲状腺癌诊断中的意义进行研究。方法:分别选取2011年1月-2013年12月我院收治的结节性甲状腺肿患者、甲状腺癌患者和正常健康者各60例作为本研究的观察对象,对三组观察对象TG、TG-Ab水平进行比较分析。结果:结节性甲状腺肿组、健康组患者TG阳性率分别为6.67%、8.33%,差异无统计学意义(P0.05);两组患者TG-Ab阳性率则分别为8.33%和11.67%,差异无统计学意义(P0.05)。而甲状腺癌组患者TG、TG-Ab阳性率分别为33.33%、40.00%,与其他两组比较差异具有统计学意义(P0.05)。在结节性甲状腺肿患者中,其中结节液化型TG阳性率、TG-Ab阳性率明显高于非结节液化型,差异具有统计学意义(P0.05)。在甲状腺癌患者中,其中颈部淋巴结阳性者TG阳性率、TG-Ab阳性率明显高于颈部淋巴结阴性者,差异具有统计学意义(P0.05);单结节癌灶与多结节癌灶在TG阳性率、TG-Ab阳性率差异无统计学意义(P0.05)。结论:临床上采用TG、TG-Ab阳性率测定的方法对甲状腺肿、甲状腺癌进行鉴别和确诊是比较可靠的,值得推广应用。     

超声刀在开放性甲状腺次全切除术中的应用效果观察

目的:探讨开放性甲状腺次全切除术中应用超声刀的效果.方法:回顾性分析我院2006年7月-2012年7月收治的甲状腺次全切除术患者860例,按随机化原则分为超声组440例和电刀组420例,记录分析手术一般情况及并发症情况.结果:超声组术中切口长度、术中出血量、手术时间均较电刀组好,两组比较差异显著有统计学意义(P＜0.05);超声组在暂时性喉返神经损伤、术后出血方面少于电刀组,两组比较差异显著有统计学意义(P＜0.05).结论:甲状腺次全切除术中应用超声刀术后并发症少,术中切口长度、出血量及手术时间均显著减少,是疗效较好的术式,值得推广应用.     

腹腔镜子宫次全切除术对患者机体应激的影响

为了评估腹腔镜次全子宫切除（LSH）和开腹次全子宫切除（TASH）对机体应激影响,选用以随机方式分为开腹次全子宫切除组（A组）、腹腔镜次全子宫切除组（B组）。取术前24h、术后24h和术后72h患者外周静脉血,分别检测血清中皮质醇（Cor）、甲状腺相关激素（FT3、FT4、TSH）水平的变化。开腹组内皮质醇水平于术后24h则高于术前（P=0．016）,而腹腔镜组升高不显著（P=0．057）,两者比较差异有统计学意义（P=0．038）。术后24h,两组病人FT3浓度下降,此时点两组间差异无统计学意义（P=0．256）。术后72h,两组间差异有统计学意义（P=0．042）。术后24h开腹手术组FT4浓度低于同时点腹腔镜手术组FT4浓度（P=0．040）。术后72h两组均能恢复至术前水平（pA=0．412,pB=0．578）,两组间差异无统计学意义（P=0．723）。TSH的比较：开腹组与腹腔镜组比较术后24h均下降,术后72h又有所上升,但各时点变化均不显著（P〉0．05）,且两组间差异也无统计学意义（P〉0．05）。腹腔镜次全子宫切除比开腹次全子宫切除对机体的应激影响小。     

不同手术方式对分化型甲状腺癌患者预后的影响

目的：探讨不同手术方式对分化型甲状腺癌患者临床治疗的效果及其预后的影响。方法：回顾性分析了2005.02-2012.07入住我院的60例分化型甲状腺癌患者的临床资料,采用如下三种不同的治疗方式：甲状腺切除术联合双侧中央区颈淋巴结清扫手术;保留对侧喉返神经入喉处甲状腺组织的甲状腺次全切除术联合单侧改良颈淋巴结清扫手术;保留对侧喉返神经入喉之处甲状腺组织的甲状腺次全切除手术联合双侧改良颈淋巴结清扫手术。结果：（1）上述三组患者术后,患者的甲状旁腺的功能低下之间均存在显著的统计学差异（P〈0.01）,三组喉返神经损伤的发生率之间也存在显著的统计学差异（P〈0.01）;本组60例患者均获10-172个月（平均为93.5±10.2）的随访,上述三种手术方式下患者的癌症复发率分别为77.8%、4.5%及45.0%,三组具有显著的统计学差异（P〈0.01）;生化治愈率分别为27.8%、95.5%及50.0%;平均生存时间分别为（92.3±12.5）个月、（105.8±14.5）个月及（112.3±20.9）个月。（2）三组患者术后生存质量总得分分别为（122±9）、（118±8）及（125±9）分。结论：与甲状腺切除术联合双侧中央区颈淋巴结清扫手术进行对比,保留对侧喉返神经入喉处甲状腺组织的甲状腺次全切除术联合单侧改良颈淋巴结清扫手术与保留对侧喉返神经入喉之处甲状腺组织的甲状腺次全切除手术联合双侧改良颈淋巴结清扫手术在生存时期、术后生存质量两个方面不具显著性差异。     

Bocio intratorácico tóxico. Perfil clínico y morbilidad quirúrgica en una unidad de cirugía endocrina

BackgroundThe development of postsurgical complications is exacerbated when several risk factors coincide in the same patient. Objective: To analyze the results of surgery for toxic intrathoracic goiter in terms of (a) the need for sternotomy; (b) morbidity and mortality; and (c) remission of compressive symptoms.Material and methodsA review (1980–2002) was carried out of 43 cases of toxic intrathoracic multinodular goiter according to Eschapase's definition (3 cm below the sternal manubrium) occurring in patients without previous thyroid surgery who underwent total thyroidectomy. There were 2 control groups: I (non-toxic intrathoracic goiter, without recurrence and not requiring total thyroidectomy) and II (non-intrathoracic, non-toxic goiter without recurrence, requiring total thyroidectomy). The following variables were analyzed: sociopersonal, clinical and surgical characteristics, morbidity, mortality, and outcome.ResultsCompared with the control groups, the patient group had longer disease duration and was older. In 6 patients (14%) 1 was difficulty in intubation, and 2 patients required fiberoptic intubation. All goiters could be extirpated through the cervical route. The morbidity rate was 37% (n=16). Notably, 4 were recurrent lesions (9%), 1 of which was definitive, and 14 were hyperparathyroidism (33%), one of which was definitive. The only difference between the control groups and the patient group was a greater incidence of transitory hypoparathyroidism in the patient group than in control group II (33% versus 15%; p=0.0103). Surgical outcomes were excellent in terms of symptom remission.ConclusionsIn any unit with ample experience of endocrine surgery, total thyroidectomy in toxic intrathoracic goiter can be carried out with a low risk of postsurgical complications, a low incidence of sternotomies and complete symptom remission. In intrathoracic goiter surgery, the presence of associated hyperthyroidism does not increase postoperative morbidity.     

Preoperative and Postoperative Evaluation of Thyroid Disease in Patients Undergoing Surgical Treatment of Primary Hyperparathyroidism

ObjectiveTo evaluate the occurrence of thyroid disease in patients undergoing parathyroidectomy for primary hyperparathyroidism.MethodsIn this case series, records of all patients with a diagnosis of primary hyperparathyroidism who underwent parathyroidectomy between January 2005 and December 2008 in our clinic were analyzed retrospectively. Preoperatively, all patients were evaluated with ultrasonography and parathyroid scintigraphy; when needed, thyroid scintigraphy and ultrasound-guided fine-needle aspiration biopsy (FNAB) were used. All patients underwent standard neck exploration. Postoperative histopathologic findings of thyroid tissue were classified as nodular/ multinodular hyperplasia, Hashimoto thyroiditis, papillary thyroid carcinoma, or normal.ResultsFifty-one women and 9 men were included. In the 60 patients, preoperative ultrasonography revealed thyroiditis (without nodules) in 13 (22%), a solitary nodule in 9 (15%) (coexistent with thyroiditis in 7 patients), multinodular goiter in 24 (40%) (coexistent with thyroiditis in 5 patients), and normal findings in 14 (23%). Rates of thyroiditis and nodular goiter were 42% and 55%, respectively. Collectively, prevalence of thyroid disease was 77%. Total thyroidectomy was performed in 27 patients, and hemithyroidectomy was performed in 15 patients. Indications for total thyroidectomy were nondiagnostic or suspicious FNAB results in 5 patients, hyperthyroidism in 4 patients, ultrasonography findings in 11 patients, and intraoperatively recognized suspicious nodularity in 7 patients. Postoperatively, thyroid carcinoma was diagnosed in 9 patients (15%).ConclusionsThyroid disease, particularly thyroid carcinoma, is common in patients with primary hyperparathyroidism. This association should be considered when selecting the surgical procedure. Intraoperative evaluation of the thyroid is as important as preoperative evaluation with ultrasonography and FNAB in patients with thyroid disease and primary hyperparathyroidism. (Endocr Pract. 2010;16:7-13)     

Histopathological evaluation of recurrent goiter

The recurrent goiter is the regrowth of thyroid tissue after thyroidectomy. An inadequate surgical removal of the thyroid gland, lack of substitution therapy and pathological stimulation of the thyroid growth can all promote the recurrence. The aim of this study was to find the connection between the histopathological findings during the first and second operation and the recurrence of goiter. The study group consisted of 29 women and 1 man. The mean time to recurrence was 15 years. The most frequent histopathological finding during the first and second operation was struma nodosa. According to our observations different histopathological findings were found in 63.4% cases after primary and secondary thyroidectomy. Some genetic investigations showed that nodules in recurrent goiters did not derive from nodules left during the first operation but from a group of cells which had high growth potential. Thus, not only the operation technique and substitution after operation are key factors of successful therapy of goiter, but also other factors which stimulate the re-growth of thyroid tissue.     

甲状腺再次手术治疗的临床分析

目的:探讨甲状腺再次手术的原因、手术方式的选择和手术效果以及患者的预后情况。方法:统计哈尔滨医科大学附属第二医院普外科2001年1月到2015年9月期间收治的1600例初次行甲状腺手术的患者,回顾分析其中175例再次行甲状腺手术患者的临床资料。结果:甲状腺再次手术采用双侧甲状腺次全切除术为92例,单侧甲状腺次全切除术为72例,甲状腺癌根治术为11例。甲状腺再次手术患者术后出现甲状腺功能减退、气管和喉返神经损伤、出血以及缺钙引起的手足抽搦等概率高,与首次手术比较差异有统计学意义(P0.05)。术后1年内对再次手术的患者进行随访,其中复发12例(病理确诊为甲状腺癌3例,结节性甲状腺肿9例),其他类型甲状腺疾病无复发。结论:甲状腺再次手术较初次手术难度较大,术中及术后并发症较多,再次手术应谨慎选择术式及术中精细操作。     

Nonfunctioning Parathyroid Carcinoma: Case Report and Review of Literature

ObjectiveTo report a case of nonfunctioning parathyroid carcinoma that was incidentally found during a thyroidectomy for multinodular goiter.MethodsWe present a case report, detailing the clinical course and histologic findings in a patient with a nonfunctional parathyroid carcinoma. The related literature is also reviewed.ResultsA 67-year-old woman presented with a 30-year history of a multinodular goiter that was symptomatic. A total thyroidectomy was performed. Histologic examination revealed not only a multinodular thyroid but also a mass in the left lobe, which was diagnostic of a parathyroid carcinoma. Serum calcium and parathyroid hormone levels were normal postoperatively. Eleven months after the initial operation, a suprasternal mass developed, and she underwent neck reexploration and subtotal resection of an invasive recurrent nonfunctioning parathyroid carcinoma. The serum parathyroid hormone and calcium levels were normal before and after the operation. Postoperatively, the patient underwent radiation therapy. Twenty-three months after the initial operation, a computed tomographic scan of the chest revealed an interval increase in size of a nodule in the left lower lobe of the lung, and 30 months after her initial operation, she underwent resection of an isolated, 1-cm (greatest diameter), metastatic parathyroid carcinoma in the left lower lobe of the lung. The patient is currently doing well without evidence of recurrent disease.ConclusionNonfunctioning parathyroid carcinomas are difficult to diagnose and to treat. Recurrent disease after operation is common, and radiation therapy may help stabilize tumor growth. Patients with nonfunctioning parathyroid carcinomas appear to have a poorer prognosis than do those with functioning parathyroid cancers. (Endocr Pract. 2007;13:750-757)