全甲状腺切除治疗甲状腺癌686例体会

Experience of 686 cases with thyroid cancer treated by total thyroidectomy

目的:探讨全甲状腺切除手术适应证的选择和并发症的防治,评价全甲状腺切除手术的安全性。方法:回顾性分析河南省肿瘤医院头颈外科2009-2014年间686例全甲状腺切除手术患者的临床病理资料。结果:术中采用精细化被膜操作,全组至少原位保留甲状旁腺一枚。每例均至少合并一侧Ⅵ区淋巴清扫。全组发生暂时性甲状旁腺功能低下者225例(32.8%),出现低钙血症症状者132例(19.2%),2例发生永久性甲状旁腺功能低下。发生喉返神经损伤者18例(2.6%)。结论:全甲状腺切除是安全的手术方式,在严格掌握手术适应证的基础上,通过术中精细的被膜操作,可有效保护喉返神经及甲状旁腺,降低术后并发症。

Objective：To investigate the indications,complications and safety of the total thyroidectomy in the management of thyroid cancer. Methods：All 686 cases underwent total thyroidectomy between January 2009 and June 2014 in Henan Cancer Hosipital were studied. Results：With precisely dissecting the thyroid glands envelope and pro-tecting the parathyroid gland blood supply,at least one of the parathyroid gland was preserved and remained in situ in all cases. At least half of central lymph node dissection was underwent in all cases. 225 cases（32. 8% ）had de-creased parathyroid hormone levels and 132 cases（19. 2% ）had complicated with short term hypocalcemia postoper-atively,only 2 cases had complicated with permanent hypoparathyroidism. In addition,postoperative hoarseness were observed in 18 cases. Conclusion：Total thyroidectomy is a safe procedure in the management of thyroid cancer if the operation indication is restrictedly controlled. Precisely protecting the parathyroid glands blood supply and laryngeal nerve is the key point to prevent the major complications.