甲状腺功能衰竭法在甲状腺功能亢进手术前准备的临床应用

Clinical application of thyroid defunctionalization method for the preoperative preparation of hyperthyroid operation

目的:探讨甲状腺功能衰竭法应用于甲亢患者术前准备的临床效果。方法:选择86例采用手术治疗的甲亢患者,按照随机数字表法分为研究组和对照组,每组43例。研究组术前应用甲状腺功能衰竭法,对照组术前应用抗甲亢药物联合碘剂准备法,比较两组就诊时和手术前游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)水平,并比较两组手术时间、术中出血量、住院时间、住院费用和术后并发症发生率。结果:手术前研究组血清FT3、TSH水平均低于对照组(P<0.05及P<0.01);两组手术方式比较差异无统计学意义(P>0.05)。对照组术中见甲状腺表明血管曲张,弹性差,腺体充血明显,质地硬而脆,触之容易出血;研究组血管曲张、腺体组织充血不明显,质地柔韧,不易出血。研究组手术时间、出血量及住院时间均少于对照组(P<0.01),住院费用和并发症发生率均低于对照组(P<0.01及P<0.05)。结论:甲状腺功能衰竭法用于甲亢的手术前准备可有效减少手术时间、术中出血量和住院时间,降低并发症发生率和住院费用。

Objective： To investigate the clinical effect of thyroid defunctionalization method for the preoperative preparation of hyperthyroid operation. Methods： Eighty- six patients with hyperthyroidism were randomly divided into study group and control group with 43 cases in each group. The patients of the study group were treated with thyroid defunctionalization method before operation, while the control group was treated with anti-hyperthyroid drugs combined with iodine preparation preoperatively. The levels of three iodine thyroid （FT3）, free thyroid hormone （FT4） and thyroid stimulating hormone （TSH） were compared between the two groups arrived at hospital and before treatment, and the operation time, bleeding volume, length of stay, hospitalization expenses and postoperative complications were also compared. Results： The levels of serum TSH and FT3 of the study group before operation were lower than those of the control group （ P 〈 0.05, P 〈 0.01 ）. There was no statistical significance between the two groups （P 〉 0.05 ）. The thyroid of the patients of the control group showed varix, poor elasticity, obvious hyperaemia in gland, harder and brittle, and easy to bleed, while it was flexible and not apt to bleed, and no obvious varix and hyperaemia in gland tissue were found in study group. The operation time, hospitalization time and bleeding volume of the study group were less than those of the control group （ P 〈 0.01 ）. The cost of hospitalization was lower than that of the control group （P 〈0.01 ）. The complication rate of the study group was lower than that of the control group （P 〈 0.05 ）. Conclusion： Thyroid defunctionalization method for the preoperative preparation of hyperthyroid operation can effectively reduce the operation time, blood loss, complication rate, hospitalization time and the cost of hospitalization.