甲状腺次全切除术与全切除术治疗甲状腺癌合并甲状腺多发结节的效果及对喉返神经和甲状旁腺功能的影响

Curative effect of lateral subtotal thyroidectomy and total thyroidectomy on thyroid tumor complicated by multiple thyroid nodules and theirs influence on recurrent laryngeal nerve and parathyriod function

目的比较甲状腺癌合并甲状腺多发结节患者行侧叶次全切除术与全切除术的效果及对喉返神经(RLN)和甲状旁腺功能的影响。方法回顾性分析2019年3月至2021年3月山西白求恩医院收治的140例甲状腺癌合并甲状腺多发结节手术患者的临床资料,根据甲状腺切除范围将其分为全切组(66例)与次全切组(74例),比较两组手术相关指标、RLN损伤情况、甲状旁腺功能状况、术后并发症和5年生存情况。结果全切组手术时间长于次全切组,术中出血量多于次全切组(t=12.15、13.96,P均<0.05)。全切组术后暂时性RLN受损、永久性RLN受损发生率高于次全切组,但差异未见统计学意义(P>0.05)。全切组术后甲状旁腺激素水平低于次全切组(t=2.73,P<0.05),暂时性甲状旁腺功能受损发生率(27.27%,18/66)高于次全切组9.46%,7/74,P<0.05,但两组永久性甲状旁腺功能受损发生率比较差异未见统计学意义(P>0.05)。全切组术后饮水呛咳、切口血肿等并发症总发生率(22.73%,15/66)高于次全切组(9.46%,7/74),但差异未见统计学意义(P>0.05)。全切组及次全切组中位生存时间估计值分别为57.91个月与55.27个月,两组5年生存情况比较差异未见统计学意义(χ^(2)=3.59,P>0.05)。次全切组复发率(18.92%,14/74)与全切组(7.58%,5/66)比较差异未见统计学意义(χ^(2)=3.83,P>0.05)。结论甲状腺全切术能保障病灶切除的彻底性,术后复发率低,但手术操作复杂,风险高,术后永久性RLN损伤及甲状旁腺功能受损发生率高于次全切术。

Objective To compare the efficacy of lateral subtotal thyroidectomy and total thyroidectomy on thyroid tumor complicated by multiple thyroid nodules and theirs influence on recurrent laryngeal nerve and parathyriod function.Methods The clinical data of 140 patients with thyroid tumor complicated by multiple thyroid nodules treated by surgery in Shanxi Bethune Hospital from March 2019 to March 2021 were retrospectively analyzed.According to the extent of thyroidectomy,the patients were divided into total thyroidectomy group(66 cases)and subtotal thyroidectomy group(74 cases).The operation-related indicators,RLN injury,parathyroid function,postoperative complications and 5-year survival were compared between the two groups.Results The operation time of the total thyroidectomy group was longer than that of the subtotal thyroidectomy group,and the intraoperative blood loss of the total thyroidectomy group was more than that of the subtotal thyroidectomy group(t=12.15,13.96;all P<0.05).The incidence of postoperative temporary RLN damage and permanent RLN damage in the total thyroidectomy group were higher than those in the subtotal thyroidectomy group,but the differences were not significant(P>0.05).The postoperative parathyroid hormone level in the total thyroidectomy group was lower than that in the subtotal thyroidectomy group(t=2.73,P<0.05),and the incidence of temporary impaired parathyroid function in the total thyroidectomy group(27.27%,18/66)was higher than that in the subtotal thyroidectomy group(9.46%,7/74,P<0.05).However,there was no significant difference in the incidence of permanent parathyroid dysfunction between the two groups(P>0.05).The total incidence of postoperative complications,such as chocking and wound hematoma,in the total thyroidectomy group(22.73%,15/66)was higher than that in the subtotal thyroidectomy group(9.46%,7/74),but the difference was not significant(P>0.05).The estimated median survival time of the total thyroidectomy group and subtotal thyroidectomy group were 57.91 months and 55.27 months,respectively,and there was no significant difference in 5-year survival between the two groups(χ^(2)=3.59,P>0.05).There was no significant difference in the recurrence rate between the subtotal thyroidectomy group(18.92%,14/74)and the total thyroidectomy group(7.58%,5/66),χ^(2)=3.83,P>0.05.Conclusions Total thyroidectomy can guarantee the completeness of the lesion resection with low postoperative recurrence rate,but the operation is complicated,with high risk,of which the incidence of permanent RLN injury and parathyroid dysfunction after surgery are higher,compared with subtotal thyroidectomy.