双侧结节性甲状腺肿合并桥本甲状腺炎不同术式的疗效比较

Efficacy comparison among different surgical procedures for bilateral nodular goiter with concomitant Hashimoto's thyroiditis

目的:比较不同术式对双侧结节性甲状腺肿(NG)合并桥本甲状腺炎(HT)的疗效。方法:收集2006年1月—2013年7月经手术治疗并病理证实的双侧NG合并HT患者的临床资料,将患者按照手术切除范围分为甲状腺大部/部分切除组、甲状腺次全切除组、甲状腺全切除组,每组均选取30例,比较各组术前、术中及术后相关指标。结果:3组患者术前临床资料具有可比性(均P>0.05);大部/部分切除组手术时间明显短于另两组(均P<0.05),而术中出血量、住院总天数、术后住院天数、留置引流天数、引流量方面,3组间差异均无统计学意义(P>0.05);3组均未发生术后大量出血及永久性声音嘶哑和低钙血症,暂时性声音嘶哑发生率差异无统计学意义(P>0.05),全切除组暂时性低钙血症发生率高于另两组(均P<0.05),而大部/部分切除组复发率高于另两组(均P<0.05)。结论:双侧NG合并HT行甲状腺大部/部分切除术手术时间短,但复发率较高;全切除术发生暂时性低钙血症较多。

Objective： To compare the efficacy of different surgical procedures in treatment of bilateral nodular goiter （NG） with concomitant Hashimoto’s thyroiditis （HT）. Methods： The data of patients with bilateral NG and concomitant HT that were treated by surgery and confirmed by pathological examination from January 2006 to July 2013 were collected. According to the resection scope, the patients were divided into subtotal/partial thyroidectomy group, near total thyroidectomy group and total thyroidectomy group, and 30 cases for each group were selected. The pre-, intra- and postoperative clinical parameters among the 3 groups were compared.Results： The preoperative clinical data among the three groups were comparable （all P〉0.05）. The operative time in subtotal/partial thyroidectomy group was significantly shorter than that in other two groups （both P〈0.05）, while there were no statistical differences in terms of the intraoperative blood loss, length of total hospital stay, length of postoperative stay, drainage retention time and drainage volume among the 3 groups （all P〉0.05）. No massive postoperative hemorrhage, permanent hoarseness, or hypocalcemia occurred in any of the groups, and no statistical difference was noted in the incidence of transient hoarseness among the 3 group （P〉0.05）. The incidence of transient hypocalcemia in total thyroidectomy group was significantly higher than that in other two groups （both P〈0.05）, while the incidence of recurrence in subtotal/partial thyroidectomy group was significantly higher than that in the other two groups （both P〈0.05）.Conclusion： For NG with concomitant HT, subtotal/partial thyroidectomy has a shorter operative time but a higher recurrence rate, while total bilateral thyroidectomy has a higher incidence of temporary hypocalcemia.