甲状腺肿瘤手术222例疗效分析

Evaluation of therapeutic effcts of operation on 222 cases of thyroid gland tumors

目的探讨甲状腺肿瘤外科治疗效果。方法回顾性分析1996-2005年间222例甲状腺肿瘤患者的临床资料。结果166例行囊内手术的甲状腺良性肿瘤中，术后喉返神经损伤6例，其中永久性喉返神经损伤2例（1％），暂时性喉返神经损伤4例（2％）；甲状腺癌囊内手术10例，1例喉返神经损伤（0．5％）。喉返神经损伤发生率与非囊内手术组对照差异有统计学意义（P〈0．01），术后无出血和甲状旁腺功能低下（P〈0．01），10例行二次手术，复发率为4．5％（P〈0．01）。42例行非囊内手术的甲状腺良性肿瘤中，术后喉返神经损伤7例，永久性喉返神经损伤2例（1％），暂时性喉返神经损伤5例（2％）；8例行二次手术，复发率为4％。非囊内手术甲状腺癌4例，1例喉返神经损伤（0．5％）。非囊内手术术后4例出血和2例甲状旁腺功能低下。结论遵循甲状腺肿瘤正确外科治疗原则是防止复发、提高手术疗效的关键。

Objective To discuss outcome of thyroid tumor patients with surgery treatment. Methods Total number of patients was 222. These patients of thyroid tumors from 1996 to 2005were recruited. The clinical and follow-up datum were retrospective analyzed. Results Benign thyroid tumors with near-total intracapsulat operation including 166 thyroid adenoma and 10 thyroid carcinoma, the incidence of recurrent laryngea nerve paralysis was 3% ,There were manifest difference of nerve paralysis between control group and intracapsulat operation group（ P 〈 0. 01 ）. All the patients have no hypocalcemia or hemorrhage after operation（ P 〈 0. 01 ）. 10 cases （4. 5 % ）received secondary surgery （P 〈 0. 01 ）. 1 cases occurred recurrent laryngeal nerve paralysis from 10 cases with thyroid cancer of intracapsulat operation. 10 cases relapsed on intracapsulat operation. 46 cases were on un-intracapsulat operation, the incidence of recurrent laryngeal nerve paralysis was 3% , 8 cases （4%） received secondary surgery. 1 cases occurred recurrent laryngeal nerve paralysis in 4 cases of thyroid cancer （0, 5% ）. 2 cases have hypocalcemia and 4 cases hemorrhage after operation. Conclusion The correct surgical management for the patientswith thyroid tumor are key points to prevent relapse and improve operational curative effct.