甲状腺功能减退症的外科干预

目的探讨伴有甲状腺功能减退症（甲减）的甲状腺疾病采用外科手段干预治疗的必要性和可能性。方法回顾2000—2005年甲状腺手术病例，对其中伴有甲减的118例诊治经过及术后疗效进行分析总结。结果桥本甲状腺炎（HT）占甲减的57、6％，医源性甲减占39．8％。HT合并甲状腺乳头状癌2例，合并B细胞淋巴瘤1例。HT手术治疗后，近全切组与峡部切除组相比前者颈部症状明显好转，术后甲状腺球蛋白抗体（TGAb）、甲状腺微粒体抗体（TMAb）下降水平较后者明显，差异具有显著性意义（P〈0．05）。全组病例术后均服用优甲乐（L-T4），随访3个月至4年未出现明显甲减体征。结论重视术前甲减的诊断，选择合理的治疗方案可避免甲减发生。已有甲减的HT并非手术禁忌证，对于药物治疗症状不缓解的病人行甲状腺近全切治疗是合理、可行的，同时可发现和治疗HT合并甲状腺癌。

Surgical treatment of hypothyroidism

Objective To investigate the necessities and feasibility of surgical treatment of thyroid diseases complicated with hypothyroidism.Methods The clinical data of 118 cases of hypothyroidism with surgery treatment performed between 2000 and 2005 were reviewed.Results Among them,57.6% were Hashimoto thyroiditis(HT)and 39.8% were iatrogenic hypothyroidism.Two cases of HT were complicated with thyroid papillary cancer.One case of HT was complicated with B cell lymphoma.In HT cases,the group of nearly total thyroidectomy excelled the group of isthmusectomy or partial thyroidectomy in the curative effect and the quantity of TGAb and TMAb descended(P<0.05).Conclusion Paying attention to the diagnosis of hypothyroidism and choosing prime treatment can avoid the occurrence of hypothyroidism.Nearly total thyroidectory is a better method when the medicine treatment was failed.It can find and treat HT complicated with thyroid cancer at the same time.