结节性甲状腺肿术后残留与复发的临床分析

目的探讨结节性甲状腺肿术后复发的原因及预防措施。方法回顾性分析本院2005年1月至2009年7月收治的967例结节性甲状腺肿患者中70例结节性甲状腺肿手术后复发情况、再手术方式及疗效。术后均予以TSH抑制剂治疗,随访0.5～5年。结果初发单侧腺体结节性肿手术47例,同侧复发20例,对侧复发13例,双侧复发14例;初发双侧腺体结节性肿手术21例,术后单侧复发14例,双侧复发7例;既往手术史不详2例,均为双侧复发。单侧腺体复发行侧叶次全切除或全切除术,双侧腺体复发行双侧甲状腺次全切除或一侧全切除、对侧次全及全切除术。复发性结节性甲状腺肿再次手术治疗的并发症发生率明显高于首次手术。结论结节性甲状腺肿术后复发率高,与其病理特点、手术方法、术后TSH抑制剂治疗不规范有关。规范手术方式、术后规律服用TSH抑制剂治疗可能减少复发率。

Clinical analysis of remnant and recurrence of nodular goiter after operation

Objective To analyze the cause of recurrence of nodular goiter after operation and how to prevent the complications.Method Seventy cases of recurrent nodular goiter among 967 cases of primary nodular goiter from January 2005 to July 2009 were studied retrospectively.The patients received TSH （ thyroid stimulating hormone ） inhibitor after operation and 0.5 to 5-year follow-up.Results In the 47 cases of unilat-eral operation,nodular goiter recurred in 20 cases in the same side,13 cases in the other side and 14 cases in the bilateral sides.In the 21 cases of bilateral operation,nodular goiter recurred in 14 cases in unilateral side,7 cases in bilateral sides.Nodular goiter recurred in 2 cases of unknown operation history.Unilateral total or subtotal thyroidectomy were performed in unilateral recurrence.Bilateral total or subtotal thyroidetomy were performed in bilateral recurrence.The incidence rate of complications was higher in reoperation group than in primary operation group.Conclusions Post operation recurrence rate of thyroid goiter is correlated with pathological charac-teristics,operation modality and incomplete TSH inhibitor treatment.Standard operation modality,TSH inhibitor treatment and cognition of pathological characteristics can decrease the recurrent rate.