巨大地方性甲状腺肿手术切除的体会

A comprehension of resection of tremendous endemic goiter

目的 总结巨大地方性甲状腺肿手术切除的经验。方法 对1980—2000年间手术治疗的19例巨大地方性甲状腺肿的临床资料进行回顾性分析。结果 均行双侧甲状腺大部或次全切除术,切除标本最大径平均为12.6cm（9～16cm）,无手术死亡病例。术后声音嘶哑、饮水呛咳、手足搐搦各1例,分别于术后13,9,5d恢复正常,18例获访3～15年,均达到临床治愈。结论 恰当的切口,充分的术野显露,气管软化的正确判定,准确识别病理状态下的甲状腺血管和毗邻神经的走行变位,有效的控制和预防出血等,均是影响巨甲手术切除疗效的重要因素。

Objective To sum up experience of resection of tremendous endemic goiter. Methods Clinical data of 19 patients of tremendous endemic goiter who received operation between 1980 and 2000 were analyzed. Results All the patients received bilateral subtotal thyroidectomy. The largest sizes of resected samples were an average of 12. 6 cm(9～16cm), and no death occurred. Postoperative phonal hoarseness was seen in 1 patient, drinking irritating in another and tetany in still another, and the above three recovered at day 13,5 and 9 after operation respectively. Following-up was conducted in 18 patients for 3～5 years and clinical cure was obtained in these cases. Conclusions Important factors affecting operational effect of tremendous endemic goiter concern about the following issues: apposite incision, full exposure of operative field, correct determination of trachemo-malacia, exact identification of pathological courser and variation of thyroid vessels and adjacent nerves, and efficient hemorrhage manipulation and prevention etc.