甲状腺腺叶切除治疗单侧甲状腺肿块82例疗效观察

目的 探讨甲状腺腺叶切除在单侧甲状腺肿块手术中的应用及其对预后产生的影响.方法 将164例由同一组外科医师手术的单侧甲状腺肿块患者分为腺叶切除组和腺部分切除组,各82例,腺叶切除组接受甲状腺腺叶切除术、腺部分切除组接受甲状腺部分切除术或次全切除术,比较两组的临床疗效和术后并发症、手术前后患者的血钙水平、甲状腺功能及复发情况.结果 与腺部分切除组比较,腺叶切除组患者手术时间(62.6±11.4比47.4±15.8)min]明显增加(P<0.05),而两组术中出血量(79.4±22.6比85.1±34.4)mL]、术后24 h引流量(47.4±12.6比45.1±14.4)mL]及术后住院天数(3.9±1.5比4.2±1.9)d]均差异无统计学意义(t=-7.06,1.25,1.09,1.12,P>0.05).两组术后出现声音嘶哑、出血、永久性甲状旁腺及甲状腺功能低下等并发症差异无统计学意义(P>0.05).术后腺叶切除组患者血钙(2.28±0.22比2.31±0.24)mmol·L-1]、游离三碘甲状腺原氨酸(FT3)(4.75±0.92比5.12±0.83)pmol·mL-1]、游离甲状腺素(FT4)(13.23±6.05比14.04±5.96)pmol·mL-1]、促甲状腺激素(TSH)(3.22±2.06比2.92±1.39)μIU·mL-1]均恢复至正常值范围,与腺部分切除组比较差异无统计学意义(t=0.46,1.98,1.44,-1.62,P>0.05).腺叶切除组二次手术率(0.0%比7.3%)、结节复发率(0.0%比18.3%)显著低于腺部分切除组,差异有统计学意义(P<0.05).结论 预防性甲状腺腺叶切除术可作为单侧甲状腺肿块的常规术式,可保证手术彻底性,减少二次手术率,且手术安全性高,值得推广.

Effect of hemithyroidectomy in the treatment of unilateral thyroid mass:An analysis of 82 cases

Objective To explore the effect of hemithyroidectomy in treating unilateral thyroid mass and its influence on patients 'prog-nosis.Methods One hundred and sixty-four cases of unilateral thyroid mass operated by the same group of surgeons were assigned into two groups,lobectomy group (n =82) was given hemithyroidectomy,and glandectomy group (n =82) was given partial thyroidectomy and subtotal thyroidectomy.The clinical effect and postoperative complications ,level of blood calcium before and after surgery ,thyroid function and recrudesce were compared .Results Compared with the partial glandectomy group ,the operation time (62.6 ±11.4 vs 47.4 ±15.8) min] in the lobectomy group was significantly increased (P <0.05),while intraoperative blood loss (79.4 ±22.6 vs 85.1 ±34.4) mL],volume of drainage 24 hours after the surgery (47.4 ±12.6 vs 45.1 ±14.4) mL] and postoperative hospitaliza-tion (3.9 ±1.5 vs 4.2 ±1.9) d] in two groups were not significantly different (t =-7.06,1.25,1.09,1.12,P >0.05).There were no significant difference in the complications such as postoperative hoarseness ,hemorrhage,perpetual hypofunction of Gley 's glands and thyroid gland between two groups (P >0.05).The blood calcium (2.28 ±0.22 vs 2.31 ±0.24) mmol· L (4.75 ±0.92 vs 5.12 ±0.83) pmol· mL-1 ],FT4 (13.23 ±6.05 vs 14.04 ±5.96) pmol· mL-1 ] and TSH (3.22 ±2.06 vs-1 ] in lobectomy group were restored to normal range after surgery ,and there were no significant differences between the two groups (t =0.46,1.98,1.44, -1.62,P >0.05).The secondary surgery rates (0.0% vs 7.3%),the recurrence rate of nodules (0.0% vs 18.3%) in the lobectomy group were significantly lower than those in the glandectomy group (P <0.05). Conclusions Prophylactic hemithyroidectomy can be used as a routine operation for unilateral thyroid mass ,which can ensure the throughness of operation and reduce the rate of secondary surgery .The safety of surgery is high and it is worthy of promotion .