摘要
目的探讨双侧结节性甲状腺肿手术切除的适宜范围。方法2003年1月至2006年6月将上海交通大学医学院附属瑞金医院263例术前诊断为双侧结节性甲状腺肿的病人随机分为A、B两组。A组118例行一侧全切除+对侧全或近全切除术;B组145例行一侧次全切除+对侧次全或大部切除术。结果A组5例、B组2例术中冰冻诊断为结节性甲状腺肿,但术后石蜡诊断为乳头状癌。A组不需再手术治疗,B组需再手术。A组3例、B组2例术后出现暂时性声嘶,但两者差异无显著性意义(P>0.05)。术后2个月A组2例仍有音调改变,不能发出高音,直接喉镜示双侧声带活动好;B组1例仍有声嘶,喉镜检查一侧声带活动减弱。两组术后各有8例和5例于术后48h内出现低钙血症表现,但两者差异无显著性意义(P>0.05),且两组均未出现永久性甲状旁腺功能低下和甲减表现。A组无复发,B组10例复发,两组相比差异有显著性意义(P<0.05)。结论对甲状腺结节直径>3.0cm,或两侧腺叶各有2个以上结节,或术中发现结节主要位于腺叶后方,或实质性冷结节者建议行甲状腺全切术。但术中应仔细解剖避免误伤喉返神经、甲状旁腺和喉上神经,全切除术治疗结节性甲状腺肿是可行的。
Objective To discussion of the thyroideetomy for bilateral multinodular goiter. Methods Form January 2003 to June 2006,263 eases admitted to our department diagnosed with bilateral multinodular goiter before operation were divided into A and B group randomly. 118 eases in A group were performed total/near total bilateral thyroideetomy, and 145 easee in B group were treated with subtotal/partial bilateral thyroideetomy. Results There were 5 amd 2 eases in A and B group separately diagnosed with multinoduler goiter pathologically in operation, but eomfirmed with papillary carcinoma after operation by pathologically. 5 eases in A group were not necessary to be operated ,but 2 eases in B group had to be operated. 3 and 2eases in A and B group separately occurred transient hoarseness after operation, but the difference was not significant （ P 〉 0.05 ）. After 2 months postoperatively,2 ease in A group had the change of the tone,and lost the timbre and focus of voice, but the movement of the true vocal cords was normal with the laryngendoseope examination ; 1 ease in B group also had hoarseness,and the movement of one side of the true vocal cords weakened. 8and 5eases in A and B group separately occurred transient hypoealeemia symptom, but the difference was not significant （ P 〉 0.05 ）. There was no ease with permanent hypoparathyroidism and thyropenia in two group. There was no ease of recurrence in A group,but 10 eases of recurrence in B group. There was significant difference between A and B group （ P 〈0.05 ）. Conclusion It is necessary to perform total thyroideetomy for the nodules greater than 3.0era, or nodules more than 2 in each lobe, or nodules lain in the back of the lobe, or the solid nodules. The total thyroideetomy is performable under the condition of carefully operating to avoid the injury of recurrent laryngeal nerve, parathyroid and superior laryngeal nerve. It can decrease the rate of recurrence and re-operation greatly.
出处
《中国实用外科杂志》
CSCD
北大核心
2007年第5期403-405,共3页
Chinese Journal of Practical Surgery
