甲状腺癌中央区淋巴结清扫和术后甲状旁腺功能减退

目的:研究不同甲状腺手术方式,尤其是中央区淋巴结清扫的作用以及术后甲状旁腺功能减退的发生。方法:连续收集同组医师操作的100例甲状腺手术病例。按手术方式分为6组:单侧甲状腺切除组12例,单侧甲状腺切除加单侧中央区颈淋巴结清扫组13例,双侧甲状腺切除组7例,双侧甲状腺切除加单侧中央区颈淋巴结清扫组32例,双侧甲状腺切除加双侧中央区颈淋巴结清扫组24例,双侧甲状腺切除加双侧中央区及患侧颈侧区颈淋巴结清扫组12例。分析其治疗结果及并发症发生率,尤其是对甲状旁腺功能的影响。结果:100例中单纯甲状腺乳头状癌74例,其中p N136例(48.6%)。除单侧甲状腺切除术外,其他手术方式术后第1天甲状旁腺激素水平均明显下降,但多可在术后1个月恢复至正常范围。75例共出现41例暂时性和4例永久性甲状旁腺功能减退(甲旁减),其发生率分别为54.7%和5.3%。行双侧甲状腺切除术病例暂时性甲旁减发生率显著高于单侧术式组,但各组间永久性甲旁减发生率无统计学差异,通过适当口服钙剂和维生素D,病人均无明显低钙症状。结论:对甲状腺乳头状癌病人行中央区淋巴结清扫,有积极而肯定的意义。对甲状旁腺功能影响多为暂时。     

甲状腺手术不同术式对甲状旁腺功能影响的临床观察

背景与目的：手术是治疗甲状腺疾病的一种极为重要的方式,而甲状旁腺功能减退是甲状腺手术的常见并发症之一。由于各类甲状腺疾病采取的手术方式不同,对甲状旁腺功能的影响也可能不同。本研究探讨甲状腺不同术式对甲状旁腺功能影响的差异并分析原因。 方法：回顾性分析2017年8月—2019年3月收治的319例甲状腺手术患者的临床资料,其中,行甲状腺单侧腺叶切除111例（单侧切除组）、行甲状腺双侧腺叶切除107例（双侧切除组）、行甲状腺双侧腺叶切除+中央区淋巴清扫术71例（双侧切除+VI区清扫组）、行甲状腺双侧腺叶切除+中央区淋巴清扫术+侧颈区淋巴清扫术30例（双侧切除+II~VI区清扫组）。术中在患侧近峡部周围被膜选择1~2点,每点注射0.1~0.2 mL纳米炭混悬注射液,所有患者均采取精细被膜解剖法原位保留甲状旁腺,若术中发现甲状旁腺无法原位保留则立即将该甲状旁腺剪成薄片或匀浆移植包埋于胸锁乳突肌中。观察并比较各组手术前后甲状旁腺激素（PTH）与血钙水平的变化以及术后甲状旁腺功能减退与低钙血症发生率。 结果：各组术前一般资料及PTH与血钙水平均无统计学差异（均P>0.05）。各组术后PTH和血钙浓度均较术前明显降低（均P<0.01）,但两者的下降幅度在术后相同时间点随着手术范围扩大而明显增大,即单侧切除组<双侧切除组<双侧切除+VI区清扫组<双侧切除+II~VI区清扫组,差异均有统计学意义（均P<0.05）。甲状旁腺功能减退与低钙血症的发生率同样随着手术范围扩大而升高,单侧切除组、双侧切除组、双侧切除+VI区清扫组、双侧切除+II~VI区清扫组甲状旁腺功能减退发生率分别为9.9%、32.7%、56.3%、73.3%,低钙血症发生率分别为0、1.9%、19.7%、50.0%,组间差异均有统计学意义（均P<0.05）。所有患者随访至24周,无永久性甲状旁腺功能减退发生。 结论：各种甲状腺手术均对甲状旁腺功能有一定的影响,且手术范围越大,甲状旁腺受损的几率越大,发生甲状旁腺功能减退的风险越高。因此,无论何种术式术中均应对甲状旁腺实施保护,术中精细操作,减少对甲状旁腺血运影响,从而尽可能地降低甲状旁腺功能减退的发生率。     

甲状腺手术中甲状旁腺显露及功能保护的临床研究

目的 探讨甲状腺术中直视下甲状旁腺的显露与定位、术中保护甲状旁腺及其血供的方法 .方法 对我院甲状腺手术患者行术中直视下显露并原位保护甲状旁腺及其血供,并观察术后甲状旁腺功能减退的发生情况.结果 259例甲状腺手术中有12例未找到明确的甲状旁腺.术中见上甲状旁腺共242枚,其中221枚(91.32%)位置恒定于甲状腺背面甲状软骨下缘水平;确切显露61枚上甲状旁腺的血管,其中42枚(68.85%)由甲状腺下动脉上行支供血.下甲状旁腺共426枚,位置变异较大,212枚(49.77%)位于甲状腺背面下1/3部分,106枚(24.88%)位于甲状腺侧叶最下端近甲状腺下动脉入腺体处;确切显露128枚下甲状旁腺的血管,其中103枚(80.47%)的血供来自甲状腺下动脉或最下动脉的分支.术后发生低钙血症者27例,其中一侧叶全切除者1例(二次手术患者),一侧叶全切加对侧叶次全切除者3例,甲状腺全切除者4例,甲状腺全切加中央组颈淋巴结清扫者7例,甲状腺全切加一侧颈淋巴结清扫者11例,甲状腺全切加双侧颈淋巴结清扫者1例.无一例发生永久性甲状旁腺功能低下.结论 甲状旁腺血供来源与其位置有密切关系.甲状腺术中完全可以直视下显露和保护甲状旁腺.预防术后甲状旁腺功能减退的关键是术中精细解剖,尽量原位保护甲状旁腺及其血供或行必要的甲状旁腺自体移植.     

内镜甲状腺手术对甲状旁腺的辨别与保护研究

目的探讨在内镜甲状腺手术中辨别和保护甲状旁腺的方法。方法回顾性分析2006年10月至2010年7月160例行颈前小切口内镜辅助甲状腺手术患者的临床资料,其中甲状腺瘤58例,结节性甲状腺肿82例,原发性甲状腺功能亢进16例,甲状腺乳头状癌4例。行一侧甲状腺次全切除术90例,双侧甲状腺次全切除术46例,甲状腺全切术20例,甲状腺全切术＋中央组淋巴结清扫4例,术中均对甲状旁腺进行精确辨认及有效保护。结果 160例均成功完成手术,术后暂时性甲状旁腺功能减退4例（2.5%）,未出现永久性甲状旁腺功能减退。结论内镜辅助甲状腺手术在术中可通过内镜放大作用对甲状旁腺进行精确辨认,并在内镜视野下完成对甲状旁腺血供的精细解剖和分离,有效的保护了甲状旁腺及其血供,明显降低了术后甲状旁腺功能减退并发症的发生率。     

达芬奇机器人甲状腺手术中甲状旁腺的损伤因素及保护

目的分析达芬奇机器人甲状腺手术中甲状旁腺损伤的相关因素,探讨甲状旁腺保护的方法,避免永久性甲状旁腺功能减退的发生。 方法回顾性分析2014年1月至2016年5月在济南军区总医院甲状腺乳腺外科行达芬奇机器人甲状腺手术的190例患者的临床资料,统计术后患者出现低甲状旁腺激素(PTH)及低血钙的发生率,分析术后发生甲状旁腺功能减退的相关因素,探讨术中如何保护甲状旁腺及其功能。 结果患者术后暂时性低PTH的发生率为20.53%(39/190),暂时性低血钙的发生率为23.68%(45/190),术后随访无永久性甲状旁腺功能减退发生。甲状腺全切术后低PTH、低血钙的发生率高于腺叶 ＋ 峡部切除术者(χ²＝14.789,11.604;P＝0.000,0.001)。行中央区淋巴结清扫的患者术后低PTH、低血钙的发生率高于未清扫者(χ²＝11.200,17.771;P＝0.001,0.000)。甲状旁腺原位保留者术后低PTH、低血钙的发生率低于切除后自体移植者(χ²＝5.536,4.851,6.140,5.453;P＝0.019,0.028,0.013,0.020)。 结论在达芬奇机器人甲状腺手术中,甲状腺全切除、中央区淋巴结清扫、甲状旁腺切除后自体移植是造成患者术后暂时性甲状旁腺功能减退的重要影响因素。在达芬奇机器人手术系统下,准确识别甲状旁腺,精细化手术操作,原位保护甲状旁腺及血供,是预防永久性甲状旁腺功能减退的有效方法。     

甲状腺手术中甲状旁腺损伤的预防和术后低钙血症的治疗

目的探讨甲状腺术中甲状旁腺损伤的预防和术后低钙血症治疗。方法选择134例接受甲状腺手术的患者作为研究对象,探讨不同手术方式术后甲状旁腺功能低下的发生情况、治疗效果及预后。结果双侧甲状腺叶全切除及中央区淋巴清扫术患者甲状旁腺功能低下症状的总发生率显著高于实施双侧腺叶次全切除术、单侧腺叶次全切除及对侧腺叶部分切除术及单侧或双侧甲状腺叶大部分切除术的患者,差异均有统计学意义(P0.05)。实施甲状腺手术后1 d,患者血清Ca2+水平均有所下降,除单侧或双侧甲状腺叶大部分切除术外,与术前相比,差异均有统计学意义(P0.05)。术后3 d血清Ca2+水平开始回升,术后5 d时,仅有一侧腺叶全切除及对侧腺叶部分切除术以及双侧甲状腺叶全切除及中央区淋巴清扫术两种术式较术前的血清Ca2+水平差异有统计学意义(P0.05)。全部患者中共有9例发生低钙血症。结论为患者实施甲状腺手术时,应避免伤及甲状旁腺及其血供,可减少低钙血症的发生。     

甲状腺不同手术方式对甲状旁腺功能的影响

目的:探讨甲状腺不同手术方式术后甲状旁腺素(PTH)、血钙的变化,总结预防甲状腺术后甲状旁腺功能减退发生的方法及并发症的处理。方法:检测2012年1—5月191例甲状腺手术患者术前及术后血清PTH、血钙,比较术前、术后的变化,并按照手术范围分7组,比较各组之间术后PTH、血钙的变化。结果:各组术后较术前比较,血钙、血PTH均明显下降(P0.05)。同组术后1 d与4 d血PTH、血钙之间比较,差异无统计学意义(P0.05)。各组低血PTH、症状性低钙血症的发生率以及术后PTH下降幅度的比较:全甲状腺切除+双侧颈中央区淋巴清除组、全甲状腺切除+一侧改良颈清+对侧颈中央区淋巴清除组甲状腺双叶切除组甲状腺单叶切除组,其差异有统计学意义(P0.05﹚,而在全甲状腺切除,以及同样范围的颈中央区淋巴清除的基础上,是否行改良颈清,对于术后低PTH血症及症状性低钙血症的发生率以及PTH下降的幅度,差异无统计学意义(P0.05﹚。低血钙的发生率比较:甲状腺单侧腺叶切除与其他6种手术方式比较、甲状腺双侧腺叶切除与全甲状腺切除+一侧改良颈清+对侧颈中央区淋巴清除比较,差异有统计学意义(P0.05﹚。结论:各种甲状腺术式对甲状旁腺功能均有不同程度的影响,手术范围越大,术后并发甲状旁腺功能减退的可能性越大。预防术后甲状旁腺功能减退的根本,就在于术中甲状旁腺的保护。     

甲状腺癌根治术致甲状旁腺功能减退的危险因素及预防

目的:探讨甲状腺癌根治术中可能导致甲状旁腺功能减退的危险因素及预防措施。方法:回顾性分析首都医科大学附属北京同仁医院普通外科2014年全年由同一外科医师实施的75例甲状腺癌手术的临床资料。结果:全组术后发生甲状旁腺功能减退20例(26.67%),其中暂时性甲状旁腺功能减退19例(25.33%),永久性甲状旁腺功能减退1例(1.33%)。甲状腺全切术患者甲状旁腺功能减退发生率明显高于甲状腺近全切除术患者(46.88%vs.11.63%,P0.05);行VI区淋巴结清扫患者甲状旁腺功能减退发生率明显高于未行VI区淋巴结清扫患者(45.71%vs.10.00%,P0.05);同时行自体甲状旁腺移植术患者甲状旁腺功能减退发生率高于未行甲状旁腺移植患者,但差异无统计学意义(50.00%vs.22.22%,P0.05)。结论:甲状腺全切和Ⅵ区淋巴结清扫是导致甲状旁腺功能减退的危险因素。术中精细解剖甲状腺后被膜,尤其是尽可能保留下甲状旁腺血运,术后应用预防性药物可能有助于甲状旁腺功能的保护。     

甲状腺全切除术后暂时性甲状旁腺功能减退危险因素分析

目的 探讨甲状腺全切除术后暂时性甲状旁腺功能减退发生的危险因素及术后常规补钙的临床价值。方法 回顾性分析2017年1-10月于北京大学深圳医院行甲状腺全切除术的237例病人资料,所有病人术后当天给予预防性补钙,且于术后第1天均复查甲状腺素（PTH）、血钙,术后1、3、6个月随访PTH及血钙水平。统计所有病人的临床数据并进行数据分析。结果 （1）237例中出现术后甲状旁腺功能减退的病人139例（58.6%）,其中暂时性甲状旁腺功能减退的病人136例（57.3%）,永久性甲状旁腺功能减退3例（1.3%）。（2）不同年龄、性别、手术路径与术后暂时性甲状旁腺功能减退发生率差异无统计学意义（P＞0.05）。（3）淋巴结清扫范围、是否再次手术及是否误切甲状旁腺与术后暂时性甲状旁腺功能减退发生率差异有统计学意义（P＜0.05）。结论 （1）术后暂时性甲状旁腺功能减退与年龄、性别、手术路径无关,淋巴结清扫范围大、再次手术及甲状旁腺误切更容易导致甲状旁腺功能减退。（2）术后第1天检测PTH能较血钙更好地预测术后甲状旁腺功能减退的发生情况。（3）术后预防性使用钙剂及维生素D3可有效预防低钙血症的发生。     

改良Miccoli术式下甲状腺全切除病人甲状旁腺功能保护的研究

目的:探讨甲状腺全切除术后病人甲状旁腺功能减退的影响因素及改良Miccoli术式对于甲状旁腺功能保护的作用。方法:回顾性分析2012年8月至2013年7月在我科行甲状腺全切除的206例病人临床病理资料,根据手术范围分为甲状腺全切除组、全切除+单侧中央区清扫组、全切除+双侧中央区清扫组,对术后甲状旁腺功能减退的可能因素进行分析。结果:206例病人中33例出现甲状旁腺功能减退(16.0%),其中1例为永久性甲状旁腺功能减退(0.5%)。不同年龄、性别、原发灶手术范围的病人术后甲状旁腺功能减退的发生无统计学差异(P0.05)。甲状腺恶性肿瘤(P=0.048)、原位保留甲状旁腺数量减少(P=0.003)、中央区淋巴结转移7枚(P=0.036)的病人,易发生甲状旁腺功能减退。结论:术后甲状旁腺功能减退与原发灶性质、原位保留甲状旁腺数量、中央区淋巴结转移数量有关,改良Miccoli术式在一定程度有利于术中更好地发现和保护甲状旁腺。     

The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients

BACKGROUND: Limited information exists about risk factors for postoperative hypoparathyroidism after bilateral thyroid surgery. METHODS: Between January 1 and December 31, 1998, bilateral thyroid surgery was performed on 5846 patients for benign and malignant thyroid disease. Data were prospectively collected by questionnaires from 45 hospitals. A logistic regression model was used to determine independent risk factors. RESULTS: The overall incidence of transient and permanent hypoparathyroidism was 7.3% and 1.5%, respectively. On logistic regression analysis, total thyroidectomy (odds ratio [OR], 4.7), female gender (OR, 1.9), Graves' disease (OR, 1.9), recurrent goiter (OR, 1.7), and bilateral central ligation of the inferior thyroid artery (OR, 1.7) constituted independent risk factors for transient hypoparathyroidism. When the multivariate analysis was confined to permanent hypoparathyroidism, total thyroidectomy (OR, 11.4), bilateral central (OR, 5.0) and peripheral (OR, 2.0) ligation of the inferior thyroid artery, identification and preservation of no or only a single parathyroid gland (OR, 4.1), and Graves' disease (OR, 2.4) emerged as independent risk factors. CONCLUSIONS: Extent of resection and surgical technique had a greater impact on the rates of permanent postoperative hypoparathyroidism than thyroid pathologic condition. In bilateral thyroid surgery, peripheral ligation of the inferior thyroid artery at the thyroid capsule should be favored over central ligation, and at least 2 parathyroid glands should be identified and preserved. High-risk procedures, such as total thyroidectomy and Graves' disease, require special surgical training and expertise.     

Risk Factors of Hypoparathyroidism Following Total Thyroidectomy for Thyroid Cancer

Background

The risk factors responsible for hypoparathyroidism after total thyroidectomy have not been completely defined. The present study evaluated one surgeon’s personal experience of postoperative hypoparathyroidism after total thyroidectomy for thyroid cancer and predisposing risk factors of postoperative hypoparathyroidism.

Methods

We performed a retrospective analysis of 531 consecutive total thyroidectomy cases for thyroid cancer operated by single surgeon at the Center for Thyroid Cancer, National Cancer Center, Korea, from March 2003 to August 2006.

Results

Postoperative hypoparathyroidism occurred in 135 patients (25.4 %), 19 of whom (3.6 % of total patients) experienced permanent hypoparathyroidism. Parathyroid autotransplantation, bilateral central lymph node dissection, gross extrathyroidal extension, and the presence of parathyroid gland in the pathologic specimen were associated with postoperative hypoparathyroidism in multivariate analysis (p < 0.05, respectively). The presence of parathyroid gland in the pathologic specimen and the early period of surgeon’s practice were statistically significant risk factors for permanent hypoparathyroidism in multivariate analysis (p < 0.05, respectively).

Conclusions

Careful surgical technique for in situ preservation of parathyroid gland and autotransplantation of inadvertently removed parathyroid gland are important, especially in case of gross extrathyroidal extension. Adequate surgical experience is also an important factor. And routine bilateral central lymph node dissection should be done thoughtfully for its effect on postoperative hypoparathyroidism.     

Autotransplantation of at least one parathyroid gland during thyroidectomy in benign thyroid disease minimizes the risk of permanent hypoparathyroidism

OBJECTIVE:Permanent hypoparathyroidism is a distressing complication of thyroid surgery. The reported incidence varies between 0.4 and 13.8 % and is directly correlated to the extent of thyroidectomy. The aim of this retrospective study was to analyze whether simultaneous autotransplantation of at least one parathyroid gland during total thyroidectomy for benign thyroid disease could reduce the risk of permanent hypoparathyroidism. METHODS: Since 01/1999 all thyroid operations are prospectively recorded. Beside daily postoperative measurement of serum calcium level, iPTH is routinely determined on the third post op day. Patients with complications are followed closely. Postoperative hypoparathyroidism persisting for more than 6 months is defined permanent. RESULTS: Between 01/1999 and 02/2001 146 total thyroidectomies for benign thyroid disease have been performed (81 pat. with Graves disease, 62 with nodular goiter, 3 with thyroiditis de Quervain/Hashimoto). In 37 pat. (25 %) at least one parathyroid gland was simultaneously autotransplanted into the ipsilateral sternocleidomastoid muscle. Group I (no parathyroid autotransplantation, n = 109) and group II (parathyroid autotransplantation, n = 37) were comparable concerning patient age, thyroid disease and lowest post op calcium level (2.07 versus 2.05 mmol/l). The incidence of postoperative symptomatic hypocalcemia (14.7 % versus 21.6 %) and temporary hypoparathyroidism (15.6 % versus 18.9 %) was higher in group II patients (n. s.). Conversely, permanent hypoparathyroidism occurred exclusively in group I patients (2.75 %), patients with parathyroid autotransplantation (group II) did not develop this complication. CONCLUSIONS: Simultaneous autotransplantation of at least one parathyroid gland during total thyroidectomy for benign thyroid disease seems to minimize the risk of permanent hypoparathyroidism. The potential of routine autotransplantation in this setting has to be evaluated. The incidence of postoperative temporary hypocalcemia may be elevated with this policy.     

Estimation of frequency of the main clinical features in patients with malignant tumor of thyroid gland after radical operative intervention

The rate of main clinical features was studied in 25 patients with the thyroid gland carcinoma after performance of total thyroidectomy, it was compared also with such a rate in patients with stable hypoparathyroidism as a complication of radical operative intervention made on thyroid gland or parathyroid glands. There was established, that nearly all physical features and majority of somatic symptoms are caused by the stable postoperative hypoparathyroidism occurrence.     

Surgeon's Approach to the Thyroid Gland: Surgical Anatomy and the Importance of Technique

The cornerstone of safe and effective thyroid surgery is thorough training in and understanding of thyroid anatomy and pathology. With appropriate techniques, total thyroid lobectomy and total thyroidectomy (which should be considered simply as a bilateral total thyroid lobectomy performed during the same operation) can be undertaken with minimal risk of damage to the recurrent laryngeal nerves, the external branches of the superior laryngeal nerves, and the parathyroid glands. Safe surgery requires a specific operative plan, progressing in a series of logical, orderly, anatomically based steps. Exposure of the thyroid gland is followed by careful dissection of the superior pole, utilizing the avascular plane between the superior pole and the cricothyroid muscle to identify and preserve the external branch of the superior laryngeal nerve. Medial retraction of the gland then allows dissection of the lateral aspect of the thyroid lobe. Protection of the recurrent laryngeal nerves and preservation of the blood supply to the parathyroid glands is best achieved by “capsular dissection,” ligating the tertiary branches of the inferior thyroid artery on the gland surface. If a parathyroid gland cannot be preserved or becomes ischemic after dissection of its vascular pedicle, it should be immediately minced and autotransplanted into the ipsilateral sternocleidomastoid muscle. The current evolution of outpatient or short-stay thyroidectomy emphasizes the need to avoid complications by utilizing meticulous surgical technique. Minimally invasive thyroidectomy utilizing endoscopic techniques may also affect the practice of thyroid surgery. Even so, understanding the surgical anatomy of the thyroid gland and its possible variations is paramount to safe and effective surgery.     

A comparison of total thyroidectomy and lobectomy in the treatment of dominant thyroid nodules

Patients with a clinically concerning dominant thyroid nodule have been managed by lobectomy or total thyroidectomy at our institution. We determined the complications associated with both approaches and the ability of thyroid lobectomy to avoid the need for thyroid hormone replacement therapy. Records of all patients with a dominant thyroid nodule managed with surgery from August 1993 through December 2000 were reviewed for demographics, history of head and neck radiation, indication for surgery, preoperative fine-needle aspirate results, final pathologic evaluation, perioperative complications, determinations of need for subsequent thyroid surgery after lobectomy, and need for thyroid hormone replacement therapy after surgery. Patients with a preoperative diagnosis of malignancy or bilateral or diffuse disease were excluded because these conditions would uniformly be managed by bilateral thyroidectomy. The complications for the lobectomy group (n = 131) compared with the total thyroidectomy group (n = 84) were: recurrent laryngeal nerve paresis (4.6% vs 2.4%), recurrent laryngeal nerve injury (0.8% vs 0), and transient hypoparathyroidism (1.5% vs 9.5%; P = 0.007). No permanent hypoparathyroidism was identified in either group. Postoperative thyroid hormone replacement was required in 64 of 131 lobectomy patients (48.8%). Complications associated with either surgery were low. Total thyroidectomy was not associated with clinically significant additive morbidity. Patients treated by lobectomy should be aware of a nearly 50 per cent chance of requiring thyroid hormone replacement. Total thyroidectomy avoids future thyroid surgery; lobectomy patients remain at risk. When complications can be minimized total thyroidectomy should be considered an option in the management for patients with dominant thyroid nodules that require surgery.     

甲状腺全切除术治疗良性甲状腺疾病128例临床疗效

目的：探讨甲状腺全切除术治疗甲状腺良性疾病的疗效及术后并发症的预防。方法：回顾性分析128例行甲状腺全切除术的甲状腺良性疾病病人的临床资料,其中首次手术者98例,再次手术者30例。分析总结该128例病人的术后并发症。结果：128例病人术后均未发生永久性甲状旁腺功能低下和永久性喉返神经损伤。首次甲状腺全切除组术后暂时性喉返神经损伤和暂时性甲状旁腺功能低下的发生率均为1．02％,再次手术组的发生率明显增高,分别为10．00％和13．33％,两组比较,Fisher精确概率P分别为0．040、0．011。两组暂时性喉上神经损伤发生率均很低,无明显差别。结论：对符合指征的良性甲状腺疾病,甲状腺全切除术是一合适的治疗选择。熟悉甲状腺解剖和精细手术操作,可有效预防并发症发生。