甲状腺机能亢进症192例外科治疗临床经验

Clinical Experience in 192 Patients with Hyperthyroidism Undergoing Subtotal Thyroidectomy

目的 总结笔者近 10年甲状腺机能亢进症 (甲亢 )外科治疗的经验。方法 对 192例甲亢接受甲状腺次全切除病人的治疗和随访资料进行回顾性分析。结果 原发性甲亢 177例 ,继发性甲亢 11例和高功能腺瘤 4例。轻、中和重度甲亢分别为 6 6 (34% ) ,82 (4 3 % )和 44 (2 3 % )例。 10 0例 (5 2 % )存在心脏损害。术中保留甲状腺左右叶各 3～ 8克。 1例术后死于甲亢性心脏病心衰。无甲状腺危象和术后甲状腺功能低下发生。所有突眼性甲状腺肿病人均感到突眼不同程度减轻。 17例 (9% )术后出现低钙症状 ,是最常见并发症。结论 甲状腺次全切除治疗甲亢远期效果良好。术前准备以碘剂加普萘洛尔联合应用效果满意。多数病人采用局部或区域麻醉可满足手术要求。术中注意保留甲状腺被膜及下动脉可降低甲状旁腺功能低下的发生率。

Objective To review clinical experience in patients with hyperthyroidism by subtotal thyroidectomy during past 10 year. Method The pateint data of treatment and follow up in 192 cases had been analyzed retrospectively. Result Primary Graves disease, secondary toxic goitres and toxic adenoma were 177, 11 and 4 cases respectively. Mild, moderate and severe hyperthyroidisms were 66(34%), 82(43%) and 44(23%), respectively. 100(52%) cases suffered from cardiothyroitoxicosis. An effort was made to leave approximately 3～8 g of thyroid remnant bilaterally. One case dead with heart failure as a result of cardiothyrotoxicosis. There was no thyroid storm and hypothyroid developed postoperatively. Ophthalmopathy alleviated in all patients. Symptomatic hypocalcemia occurred in 17(9%) cases and were the most common complication. Conclusion Subtotal thyroidectomy continues to be an excellent method of treatment for diffuse toxic goitre as a stable euthyroid state can be achieved on long term follow up. It was satisfied that preparation for surgery should be combined with Lugol's solution and propanolol. Subtotal thyroidectomy can be performed with most patients under local/regional anesthesia. In order to decrease occurrence rate of hypocalcemia, low artery and a capsular remnant of the thyroid should be left to preserve the vascular bed of the parathyroid glands.