甲状腺次全切除术术式改进的解剖基础与疗效观察

Anatomic basis and clinical effects of the modified subtotal thyroidectomy

目的:观察改良的甲状腺次全切除术治疗甲状腺良性肿瘤的疗效及安全性。方法:回顾性分析我科1998年1月～2006年12月应用改良的甲状腺次全切除术治疗的167例甲状腺良性肿瘤的临床资料,改良要点在于低位小切口,不显露喉返神经,甲状腺包膜内分离。结果:167例中,只有1例暂时喉返神经损伤,另1例为永久性喉返神经损伤,发生率为0.6%(1/167);1例术后出现暂时性甲状旁腺功能减退;随访1～8年,有2例复发,经过2次手术未见再次复发。结论:不显露喉返神经的甲状腺次全切除术是治疗甲状腺良性肿瘤的首选术式,熟悉甲状腺及其毗邻重要结构的解剖关系是预防术后并发症的关键。

Objective： To observe the effects and the safety of the reformative subtotal thyroidectomy on benign thyroid tumors. Methods： Clinical data of 167 patients with benign thyroid tumor and underwent the modified subtotal thyroidectomy from January 1998 to December 2006 was retrospectively analyzed. The highlights of modified surgery included the smaller and lower incision comparing with conventional method, unexplosion of recurrent laryngeal nerve （RLN） and the division of tumor between the gland and false capsule of the thyroid. Results： Among 167 cases, 1 patient appeared temporary recurrent laryngeal nerve paralysis postoperation, and 1 permanent recurrent laryngeal nerve paralysis （only 0.6% injury rate）. 1 patient presented a transient （only 5 days） hypoparathroidism. 2 recurred cases were cured after the second procedure and there was no recurrence again during the following-up from 1 to 8 years. Conclusions： The modified subtotal thyroidectomy is the first choice for treating thyroid benign tumor. It is important to be familiar with anatomic features of the thyroid and its adjacent structures for avoiding the postoperative complications.