非内镜微创近全甲状腺切除术与全切除术对多结节甲状腺肿的疗效比较

Efficacy comparison of non-endoscopic minimally invasive near-total thyroidectomy and total thyroidectomy in treatment of nodular goiter

目的探讨非内镜微创近全甲状腺切除术与全切除术治疗多结节甲状腺肿的临床疗效。方法选取2010年1月~2012年1月我院收治的多结节甲状腺肿患者465例,随机分成两组,观察组237例,对照组228例,观察组采用非内镜微创近全甲状腺切除术治疗,充分保留近被膜3 mm厚的甲状腺组织大约1~2 g,有效剔除肉眼能够看到的小结节,并近完全切除腺体,术后服用甲状腺素片（50~125）μg/d,对照组采用全切除术治疗,不保留患者的甲状腺组织,术后服用甲状腺素片（100~175）μg/d,观察两组治疗效果。结果经治疗后,观察组患者的暂时性声嘶症状发生率、暂时性呛咳症状发生率、暂时性甲状旁腺功能低下症状发生率以及不良反应发生率明显低于对照组（P〈0.05）,而复发率差异无统计学意义。结论对多结节甲状腺肿患者实施非内镜微创近全甲状腺切除术治疗与全切除术治疗相比较,前者患者的暂时性声嘶症状发生率、暂时性呛咳症状发生率、暂时性甲状旁腺功能低下症状发生率、不良反应发生率明显低于后者,而根治率相同,效果显著,值得临床推广。

Objective To investigate the clinical efficacy of non-endoscopic minimally invasive near-total thyroidectomy and total thyroidectomy in the treatment of nodular goiter. Methods A total of 465 patients with nodular goiter treated in our hospital from January 2010 to January 2012 were selected and randomly divided into two groups, with237 patients in the observation group and 228 patients in the control group. In the observation group, non-endoscopic minimally invasive near-total thyroidectomy was implemented, three-millimeter thick thyroid tissue（about 1-2 g） close to membrane was reserved fully, nodules visible to naked eyes were removed effectively, patients＇ glands were resected almost entirely, and postoperative oral administration of thyroxine tablets was taken（50-125） μg/d. In the control group,total thyroidectomy was implemented, patients＇ thyroid tissue was not reserved, and postoperative oral administration of thyroxine tablets was taken（100-175） μg/d. The treatment effects of the two groups were observed. Results After treatment, the incidences of temporal hoarseness symptom, temporal bucking symptom, temporal hypothyroidism symptom and adverse reactions of the observation group were significantly lower than those of the control group（P〈0.05）, with statistical significanct difference. But the recurrence rates were not different. Conclusion Comparing the implementation of non-endoscopic minimally invasive near-total thyroidectomy and total thyroidectomy in the treatment of nodular goiter, the former one is significantly lower than the latter one in the incidences of temporal hoarseness symptom, temporal bucking symptom, temporal hypothyroidism symptom and adverse reactions, but the former one has the same radical rate as the latter one and remarkable effects, which is worthy of clinical promotion.