术中腺体不同切除体积对原发性甲亢患者远期复发、甲减、康复分布状态的影响

Effects of intraoperative different resection volumes of glands on distribution states of long-term recurrence,hypothyroidism and rehabilitation in patients with primary hyperthyroidism

目的研究术中甲状腺不同切除体积与原发性甲亢患者远期复发、甲减、康复分布状态之间的关系。方法选取2011年7月~2018年10月我科收治的原发性甲亢并行甲状腺次全切除术治疗的45例患者。男6例(13.3%),女39例(86.7%);年龄20~70岁,平均(41.9±7.8)岁;BMR分度:Ⅱ度27例(60%),Ⅲ度18例(40%)。使用CT(GE64排螺旋)进行增强扫描并计算甲状腺体积,按照甲状腺切除百分比X(%)进行分组:X1,80%(含)~85%;X2,85%(含)~90%;X3,90%(含)~95%;X4,95%(含)~100%。随访6个月,统计术后复发、甲减、康复的患者数量。运用SPSS22.0软件通过Logistic回归分析以及χ2检验进行统计学分析。结果随访期间,45例患者术后复发2例(4.44%)、术后甲减3例(6.67%)、术后康复40例(88.89%)。通过Logistic回归分析,甲状腺切除百分比是影响患者术后复发、加减、康复的重要因素,数据差异有统计学意义(P<0.05)。X1、X2组术后复发例数最高,X4组术后甲减例数最高(P<0.05)。X2、X3两组患者术后康复例数最高,而两组之间比较数据差异无统计学意义(P>0.05)。结论甲状腺切除百分比与复发、加减、康复患者分布状态之间关系密切。甲状腺切除百分比位于85%~95%的患者术后康复较佳,能够明显减少术后复发或甲减的发生率。

Objective To study the relationship between different resection volumes of thyroid glands during operation and distribution states of long-term recurrence,hypothyroidism and rehabilitation in patients with primary hyperthyroidism. Methods 45 patients with primary hyperthyroidism who underwent subtotal thyroidectomy in our department from July 2011 to October 2018 were selected.There were 6 males(13.3%)and 39 females(86.7%). Ages of them ranged from 20 to 70 years old,with an average of(41.9±7.8)years.BMR indexing:27 cases(60%)in Ⅱ degree and 18 cases(40%)in Ⅲ degree.Enhanced CT(GE64 spiral)scan was performed and thyroid volume was calculated.According to the resection percentage X(%)of thyroid glands,they were divided into X1,80%(including)- 85%,X2,85%(including)-90%,X3,90%(including)-95% and X4,95%(including)-100%.They were followed up for 6months.The number of patients with postoperative recurrence,hypothyroidism and rehabilitation was counted. Statistical analysis was conducted by Logistic regression analysis and χ2 test with SPSS22.0 software. Results During the follow-up period,there were 2 cases of postoperative recurrence(4.44%),3 cases of postoperative hypothyroidism(6.67%)and 40 cases of rehabilitation(88.89%).Logistic regression analysis showed that the resection percentage of thyroid glands was an important factor affecting postoperative recurrence,addition and subtraction and rehabilitation of patients.The difference in data was statistically significant(P < 0.05).Cases of postoperative recurrence was the highest in group X1 and X2.Cases of postoperative hypothyroidism was the highest in group X4(P < 0.05).Patients in the X2 and X3 groups had the most cases of postoperative rehabilitation,but there was no statistically significant difference between the two groups(P > 0.05). Conclusion The resection percentage of thyroid glands is closely related to distribution states of recurrence,addition and subtraction and rehabilitation of patients.Patients with the resection percentage of thyroid glands between 85% and 95% have better postoperative rehabilitation,which can significantly reduce the incidence of postoperative recurrence or hypothyroidism.