结节性甲状腺肿手术腺体残留量与术后甲低发生的关系

Relationship between residual weight of glandular body and postoperative hypothyroidism for operation of nodular goiter

目的初步探讨双侧甲状腺次全切除术治疗结节性甲状腺肿时腺体残留量与术后甲低发生的关系。方法对2004年7月至2005年2月我科54例拟施行双侧甲状腺次全切除术的结节性甲状腺肿患者,于术前根据术中拟保留腺体总量随机分为A组4～7g(18例)、B组7～10g(16例)、C组10～13g(20例),术后随诊及检测血清TSH以比较术后甲低的发生率。结果共有54例纳入研究,术后3月检测血清TSH,其平均值(单位μIU/ml)分别为A组3.94±0.75、B组3.09±0.44、C组2.85±0.34,A组的TSH平均值与B组及C组比较差异有显者性(P<0.05)。随诊3个月至1年,全部病例术后无临床型甲低发生;A、B、C三组出现亚临床型甲低各有7例(7/18,38.9%)、1例(1/16,6.3%)及0例(0/20,0%),三组间有显著性差异(字2=12.67,P=0.002)。结论双侧甲状腺次全切除术治疗结节性甲状腺肿时腺体残留总量在7g以下的患者,应给予适当甲状腺素口服以防甲低和复发。

Objective To investigate the relationship between residual weight of glandular body and postoperative hypothyroidism for patients with nodular goiter after bilateral subtotal thyroidectomy.Methods From July 2004 to February 2005, 54 cases were studied.According to intraoperative preserved total weight of thyroid before operation,the patients with nodular goiter preparing to receive bilateral subtotal thyroidectomy were randomly divided into 3 groups, including group A 4～7g（18 cases）, group B 7～10g（16 cases） and group C 10～13g （20 cases）. Postoperative follow-up and detection of serum TSH were performed for comparing the incidence of postoperative hypothyroidism.Results The serum TSH was detected 3 months after operation. The average value of TSH （μIU/ml） was 3.94±0.75, 3.09±0.44 and 2.85±0.34 respectively in groupA,B,C. With follow- up from 3 months to 1 year, no clinical type of hypothyroidism was happened in all cases after operation. The subclinical type of hypothyroidism was found in 7 cases （7/18,38.9%）, 1 case （1/16,6.3%） and zoro case（0/20,0%） respectively in group A,B,C. There was significant difference between the 3 groups （X^2=12.67,P=0.002）. Conclusion When the patients with nodular goiter received bilateral subtotal thyroidectomy and residual total weight of thyroid lower than that 7 grams, a suitable dose of thyroxin should be given by oral for preventing the hypothyroidism and recurrence,