基层乡镇医院无病理诊断条件下单侧甲状腺结节术式选择

目的探讨基层医院无病理诊断条件下单侧甲状腺结节手术治疗可行的合理手术方式。方法206例单侧甲状腺结节患者分为研究组104例，对照组102例。研究组采用患侧甲状腺腺叶＋峡部切除，对照组采用患侧甲状腺部分切除、大部分切除或单纯甲状腺结节挖除。结果研究组术后病理诊断为甲状腺乳头状癌12例，无需二次手术治疗；对照组术后病理诊断为甲状腺乳头状癌10例，再行二次手术治疗，两组比较差异有统计学意义（P〈O．01）。研究组短暂喉返神经麻痹1例，对照组永久性喉返神经麻痹2例，两组均无术后呼吸困难及窒息、喉上神经损伤、甲状腺功能低下、甲状旁腺功能减退等。两组术后并发症比较差异无统计学意义（P〉O．05）。研究组随访甲状腺乳头状癌12例，患者均存活。结论患侧甲状腺腺叶＋峡部切除是无病理诊断条件下基层医院治疗单侧甲状腺结节优选且具操作性的手术术式。

Surgical options of unilateral thyroid nodules in primary hospitals without conditions of pathological diagnosis

Objective To investigate the reasonable and feasible approach, in surgical treatment of unilateral thyroid nodules in primary hospital without conditions of pathological diagnosis. Methods Two hundred and six patients with unilateral thyroid nodules were divided into the study group （ n = 104） and the control group （ n = 102）. The study grtup was treated by ipsilateral thyroid gland lobe plus unilateral isthmus resection for thyroid nodules, the control group by ipsilateral partial thyroid resection, subtotal removal, simple excavation for thyroid nodules. Results The postoperative pathological diagnosis showed papillary thyroid carcinoma in 12 patients and no secondary surgical treatment were performed in the study group, pathological diagnosis showed papillary thyroid carcinoma in 10 patients, and then underwent secondary surgery in the control group. There was a statistical signiticant difference between groups （P 〈0.01）. In study group brief recurrent laryngeal nerve paralysis was found in 1 patient, in the control group permanent recurrent laryngeal nerve paralysis was found in 2 patients. No postoperative respiratory difficulties and choking, laryngeal nerve damage, hypothyroidism, hypoparathyroidism, etc. were found in two groups. There was no statistical significant difference in post-operative complications between the two groups （ P 〉 0. 05）. In study group 12 patients with papillary thyroid carcinoma were followed up, the patient survived. Condusion Ipsilateral thyroid glandhbe plus isthmus resection is a good and feasible surgical method for unilateral thyroid nodules in primary hospital without condition of pathological diagnosis.