传统甲状腺切除术与改良小切口甲状腺切除术治疗甲状腺结节的临床疗效比较

目的 对比分析传统的甲状腺切除与改良小切口甲状腺切除术治疗甲状腺结节的临床疗效和并发症发生情况.方法 选取本院2013年3月至2015年7月间收治的88例甲状腺结节患者作为研究对象,全部患者均已确诊为甲状腺良性肿瘤.按照随机平均的原则将其分为两组,即观察组和对照组,每组44例,其中观察组患者采用改良小切口甲状腺切除术,而对照组患者采用传统的甲状腺切除术,对比分析两组患者的术后住院的时间、术中的出血量、手术时间及并发症的发生情况,采用VAS疼痛评测标准对患者术后的生活质量进行评估.结果 观察组患者的平均手术时间明显比对照组短(P＜0.05);术后住院的时间比对照组短(P＜0.05);术中出血量明显比对照组少(P＜0.05).观察组患者中未见低钙抽搐、呼吸困难、切口粘连等严重并发症,并发症的发生率明显低于对照组(P＜0.05).观察组患者的疼痛评分明显低于对照组(P＜0.05),术后的生活质量明显高于对照组(P＜0.05).结论 改良小切口甲状腺切除用于治疗甲状腺结节时的手术时间较短、术中出血量较少、平均住院的时间较短,且术后的并发症较少,具有较好的临床疗效,可有效改善患者的生活质量,可在临床上推广应用.     

颈部无疤痕内镜甲状腺切除术的手术要点

目的应用内镜微创外科技术.开展颈部无疤痕甲状腺切除术(Scarless Endoscopic Thyroidectomy ,SET). 方法切口选择在乳晕上缘、胸骨旁,在内镜下行甲状腺肿瘤或腺体次全切除术. 结果 10例术后恢复良好,无声嘶、呛咳,颈部水肿、隆起明显改善. 结论颈部无疤痕内镜甲状腺切除术,具有明显的美容效果,手术关键在于良好的显露和止血.     

颈部无疤痕内镜甲状腺切除术的手术要点

目的 应用内镜微创外科技术，开展颈部无疤痕甲状腺切除术（Scarless Endoscopic Thyroidectomy,SET)。方法 切口选择在乳晕上缘，胸骨旁，在内镜下行甲状腺肿瘤或腺体次全切除术。结果 10例术后恢复良好，无声嘶，呛咳，颈部水肿，隆起明显改善。结论 颈部无疤痕内镜甲状腺切除术，具有明显的美容效果。手术关键在于良好的显露和止血。     

甲状腺切除术治疗分化型甲状腺癌的疗效

目的 探讨甲状腺切除术治疗分化型甲状腺癌的临床疗效及安全性。方法 选取2018年2月~11月我院收治的分化型甲状腺癌患者80例,根据手术方法分为两组,其中40例采取甲状腺全切除术作为全切组,另外40例采取甲状腺次全切除术作为次全切组,比较两组临床疗效、手术时间、术中出血量、住院时间、促甲状腺激素（TSH）、甲状腺球蛋白（Tg）、抗甲状腺球蛋白抗体（TgAb）及并发症发生情况。结果 全切组总有效率为95.00%,高于次全切组的72.50%,差异有统计学意义（P＜0.05）;全切组手术时间、术中出血量均低于次全切组,差异有统计学意义（P＜0.05）;全切组患者TSH、Tg、TgAb水平均低于次全切组,差异有统计学意义（P＜0.05）;全切组并发症发生率（52.50%）高于次全切组（27.50%）,差异有统计学意义（P＜0.05）。结论 甲状腺全切除术治疗分化型甲状腺癌疗效较好,手术时间和术中出血量少,有助于改善患者甲状腺指标,但并发症相对较多。     

Development of Thyroid-Associated Ophthalmopathy in Patients Who Underwent Total Thyroidectomy

Purpose

To report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid.

Materials and Methods

Of the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy.

Results

Of the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies.

Conclusion

TAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.     

布地奈德雾化吸入对于甲状腺切除术后患者咽喉部不适的影响

目的 研究布地奈德雾化吸入对于甲状腺切除术后患者咽喉部不适症状的影响。方法 选择2018年2月~2019年7月天津市河东区第三中心医院收治的经气管插管全身麻醉的甲状腺切除术患者96例作为研究对象,采用随机数表法分为对照组与观察组,各48例。对照组采用生理盐水雾化吸入治疗,观察组采用布地奈德混悬液联合生理盐水雾化吸入治疗,比较治疗前后两组的临床疗效、呼吸道症状、伯格曼舒适度评分（BCS）及视觉模拟评分（VAS）。结果 观察组治疗总有效率为95.83%,高于对照组的62.50%,差异有统计学意义（P＜0.05）;观察组呼吸道症状总发生率为20.83%,低于对照组的58.33%,差异有统计学意义（P＜0.05）;治疗前,两组BCS评分及VAS评分比较,差异无统计学意义（P＞0.05）;治疗后,观察组的BCS评分为（2.98±0.58）分,高于对照组的（1.97±0.65）分,观察组 VAS评分为（2.23±0.78）分,低于对照组的（3.98±1.67）分,且治疗后两组BCS评分均高于治疗前,VAS评分均低于治疗前,差异有统计学意义（P＜0.05）。结论 布地奈德雾化吸入治疗能有效改善甲状腺切除术后咽喉疼痛等不适症状,加快术后恢复进程,该方法治疗效果确切,值得应用。     

内镜下甲状腺切除87例的手术配合及护理

目的 探讨内镜下甲状腺切除的有效手术配合要点及护理措施.方法 回顾性总结分析了2010年5月至2010年10月收治的87例患者的手术配合要点及护理措施.结果 87例手术均获成功,术后随访患者均对手术效果非常满意.结论 内镜下甲状腺腺切除术是安全可行的,此项技术能顺利完成,有效手术配合和护理起一定作用.患者颈部无明显瘢痕,取得了较好的手术及护理效果.     

地塞米松对甲状腺切除术后自控镇痛恶心呕吐发生率的影响

目的 观察地塞米松对全身麻醉下甲状腺切除术后患者自控静脉镇痛（PCIA）引起恶心呕吐发生率的影响。方法 选择我院择期全身麻醉下实施甲状腺切除术术后应用自控静脉镇痛泵的患者50例作为实验对象,随机分为A组和B组,每组25例。A组为实验组,自控静脉镇痛泵中药物使用包括地塞米松、地佐辛、帕洛诺司琼、舒芬太尼、生理盐水;B组为对照组,自控静脉镇痛泵中药物使用包括地佐辛、帕洛诺司琼、舒芬太尼、生理盐水。对比术后两组患者48 h内恶心呕吐发生率,术后1、4、8、24、48 h的VAS评分。结果 A组48 h内恶心、呕吐发生率分别为20.00%、16.00%,均低于对照组的60.00%和56.00%,差异具有统计学意义（P＜0.05）。两组术后1、4、8、24、48 h的VAS评分相比,差异无统计学意义（P＞0.05）。结论 地塞米松可以有效降低甲状腺切除术患者术后自控镇痛恶心呕吐的发生率,减少止吐药物的使用,减少患者术后的不良反应,提高了患者的满意度和安全性。     

Thyroid Carcinoma: Criteria in Selection of Patients for Total and Subtotal Thyroidectomy

Surgical management of patients with thyroid carcinoma continues to be a controversial subject among surgeons throughout the nation. The authors have recently treated patients with differentiated thyroid carcinoma using a selective surgical approach based on criteria classifying patients into high- and low-risk subgroups. Categorization is based on patient age, size and invasiveness of the tumor, and the presence or absence of distant metastatic disease. Women older than 50 and men over the age of 40 were classified as “high-risk” patients. Other criteria qualifying patients for high-risk categorization included lesion size greater than 3 cm and/or the presence of distant metastases. For patients with follicular tumors, histologic evidence of significant vascular invasion also constituted a high-risk criterion. Patients with high-risk criteria are associated with a significantly poorer prognosis. The records of 136 patients treated from 1958 to 1978 were reviewed. The findings and research from the literature suggest that these high-risk patients, when treated by total thyroidectomy, have an overall increased rate of survival when compared with those under-going lesser surgical procedures.     

盐酸氨溴索氧气驱动雾化吸入在甲状腺术后咳痰困难的 疗效观察

目的 探讨盐酸氨溴索氧气驱动雾化吸入治疗甲状腺术后咳痰困难疗效。方法 将2015年11月~2016年12月收治的60例甲状腺术后咳痰困难者,随机分成观察组和对照组,每组30例,观察组给予盐酸氨溴索氧气驱动雾化吸入,再给予有效拍背,对照组给予庆大霉素糜蛋白酶氧气驱动雾化吸入,同样给予有效拍背,观察两组患者治疗后症状改善情况。结果 观察组咳痰困难症状缓解时间为（38.02±14.12） h,短于对照组（47.21±14.94）h,差异有统计学意义（P＜0.05)。结论 盐酸氨溴索氧气驱动雾化吸入可缩短术后咳痰困难时间,促进早日康复,提高生活质量。     

Thyroidectomy and parathyroidectomy in progeny encumbered with an insufficiency of these glands in the ancestors

Summary Thyroid and parathyroid glands were studied in 134 fetuses and neonates born of thyroparathyroidectomized rats.Parathyroid and thyroid glands in such progeny were subject to destructive and dystrophic changes indicating their functional exhaustion and premature waste. In 50–60% of the progeny presenting an aggravated history of a two-fold surgical intervention in the ancestry, microscopy demonstrated the presence of hyperemia and enlargement of the parathyroid glands. Histological examination showed a marked atrophy of the parathyroid gland parenchyma and its replacement by paretically dilated vessels.(Presented by Active Member N. N. Zhukov-Verezhnikov AMN SSSR) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 57, No. 5, pp. 86–89, May, 1964