1000例甲状腺机能亢进手术诊治经验

Experience for the Diagnosis and Subtotal Thyroidectomy in 1,000 Cases of Thyrotoxicosis

作者等26年来施行甲状腺次全切除术治疗甲亢病人1000例,其中原发性甲亢占90.5％,高功能腺瘤占4％,术后复发甲亢占3.6％,继发性甲亢占1.9％。本文强调用药前甲亢的症状,体征及基础代谢率的测定是诊断甲亢的主要依据。甲状腺次全切除术仍是目前治疗服药未能稳定的壮年人甲亢的积极而有效的一种定型手术,但要求术前准备,麻醉及术中、术后均平稳,手术过程要轻柔、准确、快捷。我们认为甲状腺肿大在80克以下者可不用横断甲状腺前肌群。本文介绍“五钳法”切除甲状腺方法。避免了许多重复切开、缝合、结扎等操作。手术死亡率为零。术后追踪,喉返神经损伤不恢复者0.9％,甲状旁腺功能不足者为0.74％,甲状腺机能低下者0.74％,甲亢复发者5.9％。

1,000 cases of subtotal thyroidectomies were performed for thyrotoxicosis in recent 26 years, including 90.5％ of primary toxic goiter, 4％ high functioning adenomas of the thyroid 3.6％ recurrent toxic goter and 1.9％ secondary toxic goiter cases. The diagnosis of thyrotoxicosis depended primarily upon the signs and symptoms of the patient with the evaluation of BMR before being controlled by drugs.Subtotal thyroidectomy is still the active and effective standard operation in the treatment of thyrotoxicosis up to date, especially in adults failed to be controlled by drugs. It requires that the patient be handled smoothly through the courses of pre-operative preparation, during anesthesia and operation, and postoperative period. The operation must be performed delicately, accurately and as quickly as possible to shorten the duration of operation. It is notneccessary to transect the pre-thvroid muscles if the weight of the thyroid gland was under 80 g. The procedure of the 'Five Forceps Method' was advocated in the resection of the thyroid gland bore. No operative mortality has occurred. Follow up postoperatively revealed 0.9％ of permanent paralysis of the recurrent laryngeal nerve, 0.74％ of parathyroid functioning deficiency, 0.74％ of patient showed hypot hy roidism and 5.9％ of recurrence of toxic goiter.