105例复发性结节性甲状腺肿的外科治疗

目的探讨结节性甲状腺肿术后复发的原因、预防措施和再手术技巧。方法对我科收治的105例复发性结节性甲状腺肿的既往手术、复发情况、再手术方式及疗效进行回顾性分析。结果既往单侧手术73例,同侧复发14例,对侧复发25例,双侧复发34例;既往双侧手术者32例,单侧复发22例,双侧复发10例;2次术后复发7例,3次术后复发3例。单侧复发者行侧叶次全或全切除,双侧复发者行双侧次全切除或一侧叶全切加对侧叶次全切除,2次及3次复发者全甲状腺切除。术后规律TSH抑制治疗。100例随访1年～10年,复发4例。结论结节性甲状腺肿术后复发与其病理特点、手术方式和术后不规律TSH抑制治疗有关。认识结节性甲状腺肿结节多发性特点,规范化手术和术后规律TSH抑制治疗可有效预防复发。

Surgical treatment on postoperative recurrence of thyroid nodular goiter:a report of 105 cases

Objective To explore the cause of postoperative recurrence in patients with multinodular goiter and its prevention and operative techniques applied in reoperation.Methods Retrospectively reviewed 105 cases of multinodular goiter with postoperative recurrence accepted reoperation in our department.Results Among 105 cases,73cases previously accepted operation on unilateral lobe(partial thyroidectomy or nodular dissection),ipsilateral recurrence in 14 cases,contralateral lobe recurrence in 25cases,bilateral recurrence in 34 cases.32 patients previously underwent bilateral operation,unilateral recurrence in 22 cases and bilateral recurrence in 10 patients. For patients with unilateral recurrence,unilateral subtotal thyroidectomy or lobectomy was applied.For patients with bilateral recurrence bilateral subtotal thyroidectomyor lobectomy with contralateral subtotal resection was applied.All patients routinely took suppressive dose of thyroxine. 100 patients were followed up for 1 to 10 years,4 patients relapsed.Conclusions The pathological characteristic of nodular goiter,operation mode applied and postoperative irregular thyroxine suppressive therapy are relevant to recurrence.Understanding the progressive and multicenter formation of nodular goiter, properly applied operation and regular postoperative TSH suppressive can effectively prevent recurrence.