全甲状腺切除术293例体会

目的探讨全甲状腺切除的必要性，可能性，总结经验并指导未来的临床工作。方法本组自2009年7月至2011年5月施行甲状腺手术683例，对其中全甲状腺切除293例患者进行回顾性分析，数据采用SPSS13．0软件进行处理，对分级数据采用卡方检验、定量数据采用方差分析及独立样本t检验。所有病例术中均常规解剖显露并原位保留甲状旁腺，对于恶性疾病力争保留双侧上甲状旁腺，至少原位保留2枚甲状旁腺。术中尽可能贴近腺体结扎血管，以减少对甲状旁腺的扰动，尽可能保留甲状旁腺的血供。结果293例全甲状腺切除病例中84例（28．7％）术后出现低钙症状，绝大多数病例症状轻，在2～4d内好转。全甲状腺切除组和全甲状腺切除＋单侧中央区淋巴结清除组低钙的发生率明显低于其他组，差异有统计学意义（χ^2=21．30，P〈0．01）。随着原位保留甲状旁腺个数减少，各组间低钙血症的发生率逐渐增高，保留甲状旁腺4枚组比3枚、2枚组低钙血症的发生率明显减少差异有统计学意义（χ^2=12．72，P〈0．05）。结论本组资料提示沿海地区甲状腺分化型癌多为双侧发病，全甲状腺切除后利于I13I治疗以及通过TG水平对疗效进行监测，因此全甲状腺切除术有其存在的必要性。

Experience with 293 cases of total thyroidectomy

Objective To disscuss the necessity and feasibility of total thyroidectomy, and to guide the clinical practice in the future. Methods A retrospecti＋：e study of 683 eases of thyroid neoplasms （including 293 cases who received total thyroidectomy） was performed from July 2009 to May 2011. Statistieal analysis was performed by the chi-squarc test, analysis of variance and independent t-test , using SPSS 13.0 softeware. All cases had parathyroid glands exposed and reserved in primary sites during the operation. In the case of malignant lesion, at least 2 upper parathyroid glands of botia sides were preserved in primary sites, and all vessels were ligated close to the gland in order to reserve the blood supply of parathyroid glands. Results 28.7% cases （84/293） had symptoms of hypoealeemia after total thyroidectomy. Most of the cases only had minor symptoms and recovered in 2-4 days. The incidence rate of hypocalcemia after total thyroidectomy, total thyroidectomy or dissection of central region lymphoid nodes was significantly lower than that in other groups （X2 = 21.30, P 〈 0.01 ）. With the decrease of the number of reversed parathyroid glands in the primary site, the incidence of hypocalcemia was increasing. The rate of hypocalcemia in the group with 4 reserved parathyroid glands was ;ignifieantly lower than that in the groups with 2 or 3 reserved parathyroid glands （X2 = 12.72, P 〈 0.05 ）. Conclusions Differentiated thyroid carcinoma appears as bilateral lesion. Total thyroideetomy faeilitates radioiodine therapy and ensures postoperative monitoring by s- thyroglobine measurement in treating differentiated thyroid carcinoma. Total thyroideetomy is feasible in selected patients with differentiated thyroid carcinoma.