毒性多结节性甲状腺肿的手术术式探讨

目的:探讨毒性多结节性甲状腺肿的手术切除范围,为临床手术治疗毒性多结节性甲状腺肿提供理论依据。方法:收集2006年12月至2011年12月哈尔滨医科大学附属第一临床医学院普外科确诊且进行手术的52例双侧毒性多结节性甲状腺肿患者的临床资料,并按照术式分为次全切除组(24例)和近全/全切除组(28例)。术后通过病理检查观察其合并甲状腺癌的情况,临床观察其是否出现声音嘶哑(喉返神经损伤)和低钙血症(甲状旁腺损伤)情况,并随访患者甲状腺结节和(或)甲状腺功能亢进的复发情况。结果:次全切除组甲状腺癌的检出率为4.2%(1/24),近全/全切除组检出率为7.1%(2/28),两者比较差异无统计学意义(x2=0.02,P0.05);两组患者术后暂时性声音嘶哑发生率分别为4.2%(1/24)、3.6%(1/28),差异无统计学意义(x2=0.37,P0.05),术后暂时性低钙血症发生率分别为4.2%(1/24)、7.1%(2/28),差异亦无统计学意义(x2=0.02,P0.05)。近全/全切除组患者术后无甲状腺结节和(或)甲状腺功能亢进复发,次全切除组患者有5例复发,复发率为20.8%(5/24),两组比较差异有统计学意义(x2=4.28,P0.05)。结论:甲状腺近全/全切除术比次全切除术更能减少毒性多结节性甲状腺肿的复发。

The Discussion of the Thyroidectomy for Toxic Multinodular Goiter

Objective:To investigate the appropriate surgical resection range of patients suffering from toxic multinodular goiter.Methods:52 cases of toxic multinodular goiter were reviewed from 2006 to 2011. All undergone surgery were confirmed by pathological examinations in the First Affiliated Hospital of Harbin Medical University. All the cases were divided into subtotal/partial bilateral thyroidectomy (24 cases) group and total/near total bilateral thyroidectomy (28 cases)group. Postoperative clinicopathological features were observed, including being accompanied by thyriod cancer, hoarseness (recurrent laryngeal nerve injury) and hypocalcemia (parathyroid injury) and follow-up data of the postoperative outcomes (recurrence of thyroid nodules and/or hyperthyroidism) were retrospectively obtained from all the patients.Results:The detection rate of thyroid cancer was 4.2% (1/24) in subtotal/partial bilateral thyroidectomy group, 7.1%(2/28) in total/near total bilateral thyroidectomy group, and no significant difference was found between the two groups (x2=0.02, P>0.05). Postoperative transient hoarseness were 4.2% (1/24) and 3.6% (1/28), respectively, and no significant difference was found (x2=0.02, P>0.05). Postoperative transient hypocalcemia were 4.2%(1/24) and 7.1% (2/28) respectively, and no significant difference was found (x2=0.02, P>0.05). No thyroid nodules and/or hyperthyroidism recurrence was found in total/near total bilateral thyroidectomy group, but 5 cases of recurrence (5/24, 20.8%) were found in subtotal/partial bilateral thyroidectomy group and significant difference was found between the two groups (x2=4.28,P<0.05).Conclusion:Near-total thyroidectomy/total resection could reduce the recurrence more effectively than subtotal resection in the treatment of toxic multinodular goiter.