探讨甲状腺全切除术在甲状腺良性疾病治疗中的价值

Value of total thyroidectomy in the treatment of benign thyroid diseases

摘要:

目的：分析甲状腺全切除术（total thyroidectomy，TT）和甲状腺次全切除术（sub-total thyroidectomy，STT）治疗甲状腺良性疾病后的并发症、患者术后复发情况及术后甲状腺替代治疗的剂量，探讨TT在甲状腺良性疾病治疗中的地位。方法：回顾性分析我科2009年5月至2010年5月收治的双侧多发性结节性甲状腺肿共86例患者手术治疗的临床资料。依据手术方式分为２组：A组48例行双侧STT，B组38例行双侧TT。结果：经病理结果证实86例患者双侧甲状腺均为良性疾病，A组3例、B组2例发生术后暂时性喉返神经损伤（P >0.05）；A组2例、B组2例发生术后暂时性甲状旁腺功能低下（P >0.05）。A组、B组手术时间分别为：（96.85±22.93） min和（79.05±19.34 ） min（P<0.05），A组、B组术中出血量分别为：（110.33±29.98 ） ml和（58.03±20.09） ml （P<0.05），A组、B组术后替代治疗的剂量分别为：（131.77±39.19） μg/d和（300.66±48.45） μg/d（P<0.05）。A组、B组术后复发例数分别为：8例和0例，术后86例病例均无永久性甲状旁腺功能低下及永久性喉返神经损伤。结论：TT与STT相比术中出血量更少、手术时间更短，术后并发症并无明显增多，虽然术后甲状腺替代治疗的剂量明显增多，但术后复发率明显降低，因此，TT是甲状腺多发结节安全的、有效的治疗方式之一。

Abstract:

Objective：To analyze the complications，recurrence and vicarious therapeutic dosage of total thyroidectomy（TT） and sub-total thyroidectomy（STT），and to explore the clinical value of total thyroidectomy in the treatment for patients with benign thyroid diseases. Methods：Totally 86 patients with bilateral multiple nodular goiter in our department from May 2009 to May 2010 were ana－lyzed retrospectively. Patients were divided into 2 groups： group A（48 patients underwent bilateral STT） and group B（38 patients underwent bilateral TT）. Results：All 86 patients were diagnosed as benign thyroid diseases by pathologic examination. Three patients in group A and 2 in group B experienced temporary postoperative laryngeal nerve injury（P >0.05）. Two patients in group A and 2 patients in group B had temporary postoperative hypoparathyreosis（P >0.05）. The operation time was （96.85±22.93） min in group A and （79.05±19.34） min in group B（P<0.05）. The intraoperative blood loss was （110.33±29.98） ml in group A and （58.03±20.09） ml in group B（P<0.05）. The vicarious therapeutic dosage was （131.77±39.19） μg/d in group A and （300.66±48.45） μg/d in group B（P<0.05）. Eight patients in group A and no patient in group B suffered recurrence. No patient had permanent laryngeal nerve injury and hypoparathyreosis. Conclusion：With the advantages of less intraoperative blood loss，shorter operation time，lower postoperative recurrence rate and complication rate，TT is superior to STT in the treatment of thyroid multi-nodular diseases，although higher vicarious therapeutic dosage is required for STT after the surgery.