双侧多发性结节性甲状腺肿手术方式及效果分析

Analysis of the operative Methods and Effects of bilateral multiple Nodular Goiter Surgery

目的总结双侧多发性结节性甲状腺肿(双侧多发结甲)的手术方式及疗效。方法总结回顾2013年7月-2018年7月间云南省大理大学第一附属医院手术治疗双侧多发结甲205例的临床资料。全组术前均经彩超检查提示双侧多发性甲状腺结节,Ti-rads分类为2类或3类;CT平扫加增强提示双侧甲状腺多发结节,倾向良性;术中快速病理冰冻切片205例双侧均为结节性甲状腺肿,其中3例术后标本石蜡病理切片为甲状腺乳头状癌。本组继发不同程度甲状腺功能亢进17例。根据双侧多发结甲的结节数量、大小、分布等因素,对双侧均为弥漫性结节者74例行双侧甲状腺叶全切除术;对一侧为弥漫性结节,对侧多发结节病灶集中于上极或下极者,行一侧甲状腺叶全切除加对侧甲状腺叶次全切除术131例。其中对峡部并存结节的38例,同时切除峡部。结果术后随访1个月~5年,并发暂时声音嘶哑16例,占7.8%,严重者4例,占1.95%,6个月后均恢复;继发暂时甲状旁腺功能减退11例,永久性甲状旁腺功能减退2例,占0.98%;结节复发14例,占6.8%;复发结节恶变者3例,占1.46%。除外严重喉返神经损伤4例、永久性甲状旁腺功能减退2例、结节复发14例,共20例,185例效果优良,占90.2%(185/205)。结论根据双侧多发结甲的结节大小、数量、分布等因素,分别采用双侧腺叶全切除术;或一侧甲状腺叶全切除加对侧腺叶次全切除术,若峡部并存结节,同时切除峡部的手术方式是减少术后并发症、结节复发或恶变的有效方法。

Objective To summarize the operative methods and curative effect of bilateral multiple nodular goiter.Methods The clinical data of 205 patients with bilateral multiple nail fixation from July 2013 to July 2018 in the first affiliated hospital of Dali university were reviewed.All patients were diagnosed as bilateral multiple thyroid nodules by color doppler ultrasound before operation and the TI-RADS were classified as 2 or 3 categories.CT plain scan showed multiple thyroid nodules on both sides,which tended to be benign;Among 205 cases of bilateral nodular goiter,3 cases of papillary thyroid carcinoma were found in paraffin section after operation.There were 17 cases of secondary hyperthyroidism of different degree in this group.According to the number,size and distribution of the nodules,74 patients with diffuse nodules on both sides underwent total thyroidectomy,In 131 cases,one side of total thyroidectomy plus subtotal thyroidectomy was performed for diffuse nodules on one side and multiple nodules on the opposite side were concentrated in the upper or lower pole.The isthmus was resected simultaneously in 38 cases with coexistent isthmus.Results After 1 month^5 years follow-up,16 cases(7.8%)were accompanied by hoarseness,4 cases(1.95%)were serious,and all recovered after 6 months,11 cases were secondary temporary hypoparathyroidism,2 cases(0.98%)were permanent hypoparathyroidism,and There were 14(6.8%)recurrent nodules and 3(1.46%)recurrent nodules with malignant change.Except serious injury of recurrent laryngeal nerve in 4 cases,permanent hypoparathyroidism in 2 cases,recurrence of nodules in 14 cases,a total of 20 cases.185 cases with good results,accounting for 90.2%(185/205).Conclusion According to the size,number and distribution of nodules in bilateral multiple thyroid nodules,total thyroidectomy or total thyroidectomy plus subtotal thyroidectomy on one side,if isthmus coexisted nodules,at the same time,isthmus resection is an effective method to reduce postoperative complications,recurrence or malignant transformation of nodules.