结节性甲状腺肿2036例临床分析

Surgery of nodular goiter:2 036 case series study

目的 总结过去 5年间结节性甲状腺肿及其合并的癌肿和其它病变外科治疗的经验和问题 ,探讨诊断、治疗和预后。方法 回顾分析 1998年 7月至 2 0 0 3年 6月 2 0 36例结节性甲状腺肿 ,包括甲状腺癌、腺瘤、甲状腺炎和继发甲亢等并发症的诊断和手术治疗。结果 女 (1716例 )∶男 (32 0例 ) =5 .4∶1,15岁以前无性别差异 ,35岁至4 4岁之间女男发病差异达 7.2∶1,6 5岁以后差异逐渐消失。年龄 12～ 83岁 (平均 4 5岁± 11岁 ) ,2 5岁以后逐渐增加 ,5 5岁以后下降。病史 1天～ 6 0年 ,平均 3.1年。超声检查 12 6 7例 (6 2 .2 % )。甲状腺功能检查 393例 (19.3% ) ,其中异常 2 4 2例 (6 1.6 % )。ECT检查 2 6 9例 (13.2 % )。CT检查 12例 (0 .6 % )。双侧病变 170 7例 (83.8% )。临床诊断 病理符合率 86 .2 %。胸骨后甲状腺肿 2 2例 (1.1% )。结节性甲状腺肿合并甲亢 181例 (9.2 % )。合并甲状腺癌6 4例 (3.3% ) ,其中术前明确诊断 12例 (18.8% ) ,术中 术后病理证实 5 2例。复发结甲手术 92例 (4 .7% )。甲状腺双侧大部切除 938例 (4 6 .6 % ) ,单侧大部切除 6 4 3例 (31.9% ) ,部分切除 2 6 4例 (13.1% )。喉返神经损伤 8例 (0 .4 % ) ,无呼吸困难 ,其中永久性声嘶 2例 (0 .1% ) ;术后一过性抽搐 35例 (1.

Objective To identify nodular goiters with other companied thyroid disorders for surgery in our hospital over last 5 years and discuss the diagnosis,treatment and prognosis.Methods A total of 2 036 nodular goiter subjects were identified from July of 1998 to Jun of 2003,including complicated with thyroid carcinoma,adenoma,and toxic goiters,etc.The diagnosis and surgery data were reviewed.Results There were 2 036 consecutive subjects (1 716 female,320 male,F∶M=5.4∶1;no gender differences under 15 of the age;F∶M reached highest 7.2∶1 during 35～44 years of age;waned gender differences after 65;ages 12～83,mean 45±11s years,higher prevalence emerged from 25s and decreased after 55s,history of cervical mass 1 day to 60 years,mean 3.1 years).Ultrasounds were done in 1 267 patients (62.2%).Thyroid function was tested in 393 (19.3%),of which 242 showed abnormal results (61.6%).ECT was done in 269 (13.2%) subjects.CT scan was tested in 12 patients (0.6%).Bilateral lobes involved in 1 707 (83.8%) subjects.There were 1 755 (86.2%) preoperative diagnosis matched the final pathologic findings.Of which,included 22 (1.08%) introthoracic goiter,181 (9.2%) with toxic goiter,56 (2.8%) with thyroid carcinoma of which 12/56 (21.4%) were diagnosed preoperatively,and 92 (4.7%) recurrent nodular goiter.Most of the cases were with bilateral major (938,46.6%) or unilateral major thyroidectomy (643,31.9%),and partial resection (264,13.1%).There were 8 cases of recurrent laryngeal nerve paralysis,temporary 6 (0.3%) and persistent 2(0.1%),without dyspnea.There were 35 (1.7%) of temporary post-operative spasm without permanent hypoparathyroidism.There were 2 cases (0.1%) of post-operative tracheotomy because of larynx edema.Conclusion Thyroid function (FT 3,FT 4,TSH) should be tested before thyroid surgery for the patients with symptoms of hyperthyroidism.Fine needle aspiration with cytology and tumor marker evaluation should be emphasized to increase preoperative diagnosis of thyroid disorder associated with malignancy and to decrease unnecessary surgery for a number of benign thyroid disorders.High recurrent incidence of nodular goiter is of challenge requiring re-surgery,because of higher surgery related complications,which should be avoided by improved surgery and posto- perative treatments.