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。

Clinical Analysis of Thyroid Reoperation

ABSTRACT Objective: To investigate the causes of thyroid reoperation, the choice of the ways of operation and operation effect and prognosis of patients. Methods: Statistics of the second affiliated hospital of Harbin medical university general surgery during Jan- uary 2001 to September 2001 treated 1600 cases of the first line of the patients with thyroid surgery, retrospective analysis of clinical data of 175 patients with thyroid reoperation. Results: Thyroid reoperation with bilateral subtotal thyroidectomy for 92 cases, unilateral subto- tal thyroidectomy of 72 cases, radical operation for thyroid cancer for 11 cases. Postoperatively in patients with thyroid reoperation hy- pothyroidism, trachea and laryngeal recurrent nerve injury, hemorrhage and calcium causes limbs twitch probability is high, compared with surgery for the first time difference was statistically significant (P<0.05). Of reoperation of patients within 1 year of postoperative follow-up, including 12 cases recurrence (pathological diagnosis of thyroid carcinoma 3 cases, 9 cases of nodular goiter), and other types of thyroid disease recurred. Conclusion: Thyroid reoperation is complication more than difficult to postoperative, reoperation should be careful to choose operation and intraoperative fine operation.