甲状腺次全切除术后再行双侧全/近全切除术的探讨

Total or near-total bilateral thyroidectomy after subtotal bilateral thyroidectomy

目的探讨甲状腺次全切除术后再行双侧甲状腺全/近全切除术的安全性。方法分析上海交通大学医学院附属瑞金医院1995年6月至2008年6月因甲状腺良性疾病行双侧甲状腺次全切除术后复发而再行双侧甲状腺全/近全切除术的34例临床资料。结果34例中2例术中误切断右喉返神经入喉处的部分纤维,但术后6个月声带活动恢复正常,已无明显声嘶;6例术后出现低钙血症表现,其中5例于术后2周内经口服和(或)静脉补钙而消失,1例因右甲状腺乳头状癌而术中误切右上甲状旁腺再行自体移植者,至术后1年低钙血症逐渐缓解,但随访至今14个月,血钙和PTH值仍略偏低。结论只要选择好正确的暴露途径,并熟悉双侧喉返神经和甲状旁腺的解剖,术中认真仔细操作,双侧甲状腺次全切除术后再行双侧甲状腺全/近全切除术还是比较安全的。

Objective To evaluate the safety of total or near-total bilateral thyroidectomy after subtotal bilateral thyroidectomy. Methods Thirty-four cases of subtotal bilateral thyroidectomy because of benign thyroid disease were performed total or near-total bilateral thyroidectomy because of the recurrence of nodules between June 1995 and June 2008 at Ruijin Hospital of Shanghai Jiaotong University School of Medicine. The clinical data of all the cases were analyzed. Results Partial fibers of right recurrent laryngeal nerves were cut at their entrance to the larynges in 2 cases. But the mobility of the vocal cord return to normal and the hoarseness were disappeared 6 months after operation. Hypocalcaemia was occurred in 6 cases.The hypocalcaemia disappeared by calcium supplementing through oral or/and intravenously in 5 of 6 cases 2 weeks after operation. But the righr superior parathyroid was cut inadvertently in one thyroid papillary cancer case, and the case underwent parathyroid autotransplantation. Hypocalcaemia was alleviated gradually 1 year after operation in the case. The levels of calcaemia and PTH were still under the normal until 14 months after operation. Conclusion If choosing the right way to expose the remnant gland and being familiar with the anatomical position of bilateral recurrent laryngeal nerves and parathyroids, it is safety to perform total or near-total bilateral thyroidectomy after subtotal bilateral thyroidectomy.