原发性甲状腺功能亢进合并甲状腺癌的外科治疗效果观察

Curative effect observation of primary hyperthyroidism complicating by thyroid cancer

目的探讨原发性甲状腺功能亢进合并甲状腺癌的外科治疗效果。方法选择2013年5月至2014年2月在本院手术治疗的106例原发性甲状腺功能亢进合并甲状腺癌患者作为研究对象，采用计算机随机法，将其分为对照组和观察组，每组53例，对照组采用甲状腺双侧叶次全切除术，观察组采用甲状腺全切术，术后随访两年，对比两组患者的治疗效果。结果观察组患者术后出血率明显低于对照组（13．21％vs．33．96％），两组比较差异有统计学意义（χ^2=6．33，P〈0．05）；观察组患者复发率明显低于对照组（5．67％vs．28．30％），两组比较差异有统计学意义（χ^2=9．64，P〈0．05）；观察组患者术后喉返神经损伤发生率低于对照组（7．55％vs．15．09％），两组比较差异无统计学意义（χ^2=2．54，P〉0．05）；两组患者术后均未出现永久性甲状旁腺功能低下并发症。结论原发性甲状腺功能亢进合并甲状腺癌患者采用甲状腺全切除术可以有效减少并发症发生率和复发率，治疗效果显著，值得广泛应用于临床。

Objective To discuss curative effect of primary hyperthyroidism complicating by thyroid cancer. Methods 106 patients with primary hyperthyroidism complicating by thyroid cancer in our hospital from May 2013 to February 2014 were selected, and randomly divided into control group and observation group, 53 cases in each group. Control group underwent thyroid bilateral lobe sub-total thyroidectorny, while observation group underwent total thyroidectomy. Patients were followed up for two years to compare the curative effect. Results The postoperative bleeding rate of observation group was 13.21%, lower than 33.96% of control group, with statistically significant difference between two groups （χ^2=6.33, P〈0.05）. The recurrence rate of observation group was 5.67%, lower than that 28.30% of control group, with statistically significant difference between two groups （χ^2=9.64, P〈0.05）. The incidence of recurrent laryngeal nerve injury after operation was 15.09% in control group and 7.55% in observation group, without statistically significant difference between two groups （χ^2=2.54, P〉0.05）; there was no postoperative permanent hypoparathyroidism in both two groups. Conclusion Total thyroidectomy can reduce the incidence of complications and recurrence rate of primary hyperthyroidism complicating by thyroid carcinoma, with remarkable therapeutic effect, worthy of wide clinical application.