甲状腺再次手术治疗的临床分析

Clinical Analysis of Thyroid Reoperation

目的:探讨甲状腺再次手术的原因、手术方式的选择和手术效果以及患者的预后情况。方法:统计哈尔滨医科大学附属第二医院普外科2001年1月到2015年9月期间收治的1600例初次行甲状腺手术的患者,回顾分析其中175例再次行甲状腺手术患者的临床资料。结果:甲状腺再次手术采用双侧甲状腺次全切除术为92例,单侧甲状腺次全切除术为72例,甲状腺癌根治术为11例。甲状腺再次手术患者术后出现甲状腺功能减退、气管和喉返神经损伤、出血以及缺钙引起的手足抽搦等概率高,与首次手术比较差异有统计学意义(P<0.05)。术后1年内对再次手术的患者进行随访,其中复发12例(病理确诊为甲状腺癌3例,结节性甲状腺肿9例),其他类型甲状腺疾病无复发。结论:甲状腺再次手术较初次手术难度较大,术中及术后并发症较多,再次手术应谨慎选择术式及术中精细操作。

Objective：To investigate the causes of thyroid reoperation,the choice of the ways of operation and operation effect and prognosis of patients.Methods：Statistics of the second affiliated hospital of Harbin medical university general surgery during January 2001 to September 2001 treated 1600 cases of the first line of the patients with thyroid surgery,retrospective analysis of clinical data of 175 patients with thyroid reoperation.Results：Thyroid reoperation with bilateral subtotal thyroidectomy for 92 cases,unilateral subtotal thyroidectomy of 72 cases,radical operation for thyroid cancer for 11 cases.Postoperatively in patients with thyroid reoperation hypothyroidism,trachea and laryngeal recurrent nerve injury,hemorrhage and calcium causes limbs twitch probability is high,compared with surgery for the first time difference was statistically significant （P〈0.05）.Ofreoperation of patients within 1 year of postoperative follow-up,including 12 cases recurrence （pathological diagnosis of thyroid carcinoma 3 cases,9 cases of nodular goiter）,and other types of thyroid disease recurred.Conclusions：Thyroid reoperation is complication more than difficult to postoperative,reoperation should be careful to choose operation and intraoperative fine operation.