甲状腺疾病3091例外科治疗分析

Analysis of surgical treatment in 3091 patients with thyroid diseases.

目的 研究接受外科治疗的甲状腺疾病的构成 ,总结治疗效果。方法 回顾性分析 1992～ 2 0 0 3年间第二军医大学长海医院收治的 30 91例甲状腺手术病人的临床资料。结果 外科治疗的甲状腺疾病明显增加 ,该组以结节性甲状腺肿 (5 9 95 % )、甲状腺癌 (16 5 9% )为主 ,甲亢手术减少 (P <0 0 1) ,桥本病有所增加 (P <0 0 5 ) ;局限于一侧的良性疾病近来以单侧腺叶切除术 (2 1 32 % )为主 ,甲状腺癌的手术方式主要为患侧腺叶、峡部联合对侧次全切除术 ,不主张行预防性颈淋巴结清扫术 ;麻醉方式以全身麻醉为主 ;总体手术并发症发生率3 95 % ,其中术后出血 0 39% ,喉返神经损伤 0 5 8% ,喉上神经损伤 1 0 3% ,甲状旁腺永久性损伤 0 0 6 % ,甲状腺功能低下 0 5 5 % ,甲状腺危象 0 2 2 % ,死亡 2例 (0 0 6 % ) ;重视术后规范、系统的替代治疗 ;总体术后复发率2 0 1% ,近年来复发率有下降 (P <0 0 5 )。结论 该组甲状腺疾病以结节性甲状腺肿、甲状腺癌为主 ;手术方式应根据病变性质、部位、大小及淋巴结转移情况而采取个体化方案 ;专业化培训、细致操作以及全身麻醉等措施可有效减少并发症的发生 ;规范。

Objective To study the constitutes of thyroid diseases suffered surgical treatment, and sum up the therapeutic effect. Methods The clinical data of 3091 patients with thyroid diseases who suffered surgical treatment from 1992 to 2003 were analyzed retrospectively. Results Thyroid diseases suffered surgical treatment increased significantly. Most diseases of this group were nodular goiter (59.95%) and thyroid carcinoma (16.59%). Hyperthyroidism treated by operation was decreasing (P<0.01), but Hashimoto s thyroiditis was increasing (P<0.05). The primary operative modes were total thyroid lobectomy (21.32%) if thyroid benign diseases were localized in one lobe of thyroid. The most operative program of thyroid carcinoma was total affected lobectomy plus isthmus and opposite subtotal lobectomy. The prophylactic neck dissection was not suggested. The leading anesthetic modes were general anesthesia. The incidence of operative complications was 3.95%, including postoperative hemorrhage 0.39%, injury of recurrent laryngeal nerve 0.58%, injury of superior laryngeal nerve 1.03%, permanent injury of parathyroid 0.06%, hypothyroidism 0.55%, hyperthyroidism crisis 0.22% and operative mortality 0.06%. Normal and systemic postoperative thyroid replacement therapy was emphasized. The rate of postoperative recurrence was 2.01%, which had decreased several years late (P<0.05). Conclusion The main thyroid diseases of this group are nodular goiter and thyroid carcinoma. The operation modes should be individualized in light of the lesion pathology, location, size and the situation of lymph metastasis. The measures for reducing the incidence of operative complications are specialized training, meticulous operating, adopting general anesthesia and so on. Normal and systemic postoperative thyroid replacement therapy can decrease the rate of postoperative recurrence.