甲状腺良性结节手术后复发的再治疗

Analysis and retreatment on postoperative recurrence of benign thyroid nodules

目的 探讨甲状腺良性结节手术后复发的相关因素和再治疗原则。方法 对我院18年中 5 1例甲状腺良性结节手术后临床复发者的病理、手术适应证、术式以及再治疗进行回顾性分析。结果 甲状腺良性结节手术后复发与病变性质、单发或多发、手术适应证的掌握及术式的选择密切相关。 5 1例复发者中结节性甲状腺肿 2 9例 ,甲状腺瘤 2 2例 ;其中行结节摘除 2 1例 ,腺叶部分切除 16例 ,一侧腺叶次全切除 9例 ,一侧腺叶切除 5例。再手术 38例 ,行一侧腺叶切除 19例 ,一侧叶切加对侧次全切除 3例 ,一侧次全切除 7例 ,双侧次全切除 9例 ;无严重手术并发症。随访 32例再手术者 ,平均 7年 ,仅 1例结节性甲状腺肿再复发。结论 对甲状腺瘤和结节性甲状腺肿的正确诊断、明确病变的单发或多发 ,严格掌握多发性结节性甲状腺肿的手术适应证 ,并废弃结节摘除和腺叶部分切除术可降低复发率和再手术率。

Objective To investigate the factors associated with postoperative recurrence of benign thyroid nodules and its retreatment. Method A retrospective analysis was made on the pathologies, operative indications, and the types of operations in 51 postoperative recurrent cases with benign thyroid nodules in a poriod of 18 years. Result The recurrences were associated with the pathology, number of nodules, the indications and types of primary surgery. Among the 51 cases there were 29 cases with nodular goiter and 22 cases with thyroid adenoma. 21 patients had had simple nodular resection, 16 patients had partial lobe resection, 9 patients had subtotal thyroidectomy and 5 patients had thyroid lobectomy. Among 38 cases receiving reoperation, 19 cases had lobectomy, 3 cases had lobectomy plus opposite subtotal thyroidectomy, 7 cases had subtotal thyroidectomy and 9 cases had bilateral subtotal thyroidectomies without serious postoperative complications. 32 cases were followed up after secondary operation with an average period of 7 years, among which 1 case with multinodular goiter had recurrence. Conclusion Strict restriction on thyroidectomy for patients with mutinodular goiter and giving up simple nodular enucleation could help reduce postoperative recurrence of benign thyroid nodules.