双侧结节性甲状腺肿行Dunhill手术的效果观察及对甲状腺功能的影响

Observation of the effect of Dunhill surgery on bilateral nodular goiter and its effect on thyroid function

目的探讨双侧结节性甲状腺肿行一侧甲状腺全切加对侧次全切除术(Dunhill术)的效果及对甲状腺功能的影响。方法选自2017年1月至2018年1月双侧结节性甲状腺患者共80例,根据数字表法随机分为Dunhill组和全切组,全切组患者进行甲状腺全切术,Dunhill组进行Dunhill术。应用SPSS18.0统计学软件进行数据分析,围术期各项指标、血钙与PTH数值以(x±s)表示,采用独立t检验;治愈率、复发率采用χ2检验,P<0.05差异有统计学意义。结果术中出血量、镇痛剂用量、手术时长、住院时长和术后并发症发生率Dunhill组患者均少于全切组(P<0.05);Dunhill组患者临床疗效优于全切组(P<0.05),但复发率(12.5%)显著高于全切组(0%)(P<0.05);两组患者术前的血钙值与PTH值差异无统计学意义(P>0.05),术后2 d及术后6 d Dunhill组患者血钙与PTH均优于全切组(P<0.05)。结论对双侧结节性甲状腺肿两种手术方法均有效,Dunhill术复发率比甲状腺全切术高,但能有效降低术后并发症,要根据患者病情选择适宜手术方法。

Objective To investigate the effect of Dunhill operation on bilateral nodular goiter and its effect on thyroid function.Methods A total of 80 patients with bilateral nodular thyroid were selected from January 2017 to January 2018,according to the numerical table method,it was randomly divided into Dunhill group and total tangent group.Total thyroidectomy was performed in the total thyroidectomy group,Unilateral total thyroidectomy plus contralateral subtotal thyroidectomy(Dunhill)was performed in the Dunhill group.SPSS18.0 statistical software was used for data analysis,Perioperative indicators、blood calcium and PTH numerical(x±s),Independent T test was used to compare.The cure rate and recurrence rate were compared byχ2 test,P<0.05 was statistically significant.Results The results of Intraoperative blood loss、analgesic dosage、duration of surgery、length of hospitalization and incidence of postoperative complications were all lower in the Dunhill group than those in the total resection group(P<0.05);The clinical efficacy of Dunhill group was higher than that of total resection group(P<0.05),however,the recurrence rate(12.5%)was significantly higher than that of the total excision group(0%)(P<0.05);There was no significant difference between the two groups in the preoperative serum calcium value and PTH value(P>0.05),The serum calcium and PTH levels in the Dunhill group were better than those in the total resection group at 2 days and 6 days after surgery(P<0.05).Conclusion Both surgical methods are effective for bilateral nodular goiter.Dunhill has a higher recurrence rate than total thyroidectomy.However,it can effectively reduce postoperative complications,An appropriate operation method should be chosen according to patient condition.