巨大甲状腺肿50例外科治疗体会

Experience on surgical treatment of 50 patients with huge goiter

目的探讨巨大甲状腺肿的临床特点与治疗要点。方法收集内蒙古医科大学附属医院普外科2010-06-2012-06收治的肿块直径8 cm以上的50例巨大甲状腺肿患者的临床资料进行回顾性研究。结果30例行甲状腺一侧腺叶切除加对侧叶大部切除术,14例行甲状腺一侧腺叶切除术,4例行甲状腺全切除术,2例行甲状腺全切除术加颈部淋巴结清扫术。病理诊断为单纯性结节性甲状腺肿39例,甲状腺癌8例,继发甲亢者3例。术后出现短暂并发症者16例,其中术后出现甲状腺功能低下8例,甲状旁腺功能低下4例,声音嘶哑3例,术后出血1例。无死亡病例。结论巨大甲状腺肿常常合并胸骨后甲状腺肿,压迫气管,使气管变窄移位,手术操作困难,风险较高。根据不同的情况做不同处理,避免大血管和喉返神经及甲状腺旁腺的损伤。

Objective To investigate the clinical characteristics of huge goiter and main problems of surgical treatment for huge goiter .Methods A respective study was performed in 50 patients with huge goiter whose diameter was larger than 8 cm, during June 2010~June 2012 .Results Thirty patients underwent one lobe thyroidectomy plus one lobe subtotal thyroidectomy , 14 patients underwent one lobe thyroidectomy , 4 patients underwent total thyroidec-tomy, 2 patients underwent total thyroidectomy plus prophylactic peripheral lymph nodes （PLN） dissection.Patholog-ic diagnosis showed nodular goiter in 39 cases, carcinoma of thyroid in 8 cases, secondary hyperthyroidism in 3 ca-ses.Postoperative complications were found in 16 cases, including hypothyroidism in 8 cases, hypoparathyroidism in 4 cases, huarseness in 3 cases, postoperative bleeding in 1 case.No death occurred.Conclusion Huge goiter was usually complicated by substernal goiter , causing tracheal compression , narrow and displacement , so operation for huge goiter is relatively difficult with correspondingly high operation risk and morbidity .It is necessary to treat the pa-tients according to their different conditions and to prevent the injuries of blood vessels , recurrent laryngeal nerve and parathyroid .