甲状腺残体的特征及其在甲状腺切除手术中的临床意义

Thyroid extension and its clinical significance in thyroidectomy

目的探索甲状腺残体的出现频率、大小、形态、与甲状腺的位置关系等特征,以提高对甲状腺残体的认识,促进甲状腺组织的完整切除。方法选择2021年11月至2022年10月于南京医科大学第一附属医院甲状腺外科行甲状腺切除手术患者879例。术前甲状腺超声或细针穿刺细胞学检查提示单侧甲状腺肿瘤,切除病灶侧腺叶;若提示双侧甲状腺肿瘤,行甲状腺全部切除,切除甲状腺组织行快速冰冻切片病理检查。术中对甲状腺残体进行探查、解剖,根据甲状腺残体与甲状腺的位置关系,将甲状腺残体分为Ⅰ型(甲状腺下极向下突出的残体组织与甲状腺相延续)、Ⅱ型(甲状腺残体紧邻甲状腺下极,无任何组织相连)、Ⅲ型(甲状腺残体通过细窄的纤维束带与甲状腺相连)、Ⅳ型(甲状腺下方独立的甲状腺组织,与甲状腺无任何连接),记录各型残体直径、发生率。结果入组患者中252例(28.7%)接受单侧腺叶切除,627例(71.3%)接受双侧腺叶切除,共涉及1506例单侧腺叶。术后病理提示良性疾病者142例(16.2%),恶性疾病者737例(83.8%)。602侧(39.9%)甲状腺腺叶伴有甲状腺残体,其中Ⅰ型221例、Ⅱ型62例、Ⅲ型255例、Ⅳ型64例。甲状腺残体直径≤1 cm者457例(75.9%),直径>1 cm者145例(24.1%),直径最大者为4.8 cm。仅133例(22.1%)甲状腺残体可通过术前超声检查探及。结论甲状腺残体作为一种常见的甲状腺形态变异,其大小及与甲状腺腺体的位置关系具有较大变异。

Objective To improve the understanding of thyroid extension and promote the completeness of thyroidectomy by exploring the frequency,size,shape and location of thyroid remnant.Methods Between September 2011 and October 2022,879 consecutive patients from department of general surgery,the First Affiliated Hospital with Nanjing Medical University were enrolled.Preoperative thyroid ultrasound or fine needle aspiration cytology revealed unilateral Thyroid neoplasm,and the focus side lobe was removed;If bilateral Thyroid neoplasm is indicated,the thyroid gland shall be completely removed,and the thyroid tissue shall be removed for rapid frozen section pathological examination.Thyroid extension was identified and recorded intraoperatively.According to the relationship with thyroid,thyroid extension was classified into 4 types.TypeⅠ:protrusion of thyroid tissue,distinct from the lower border of the thyroid lobe;typeⅡ:adjacent to the thyroid proper without any tissue connected;typeⅢ:attached to the thyroid gland by a fibrovascular core;typeⅣ:completly separated from the thyroid gland with no connection to the thyroid gland.The type and size of each thyroid extension were recorded and analyzed.Results Among the enrolled patients,252(28.7%)underwent unilateral lobectomy,and 627(71.3%)underwent bilateral lobectomy,involving a total of 1506 sides of the thyroid gland.Thyroid extension was found in 602 separate sides of the thyroid(39.9%).The incidence of typeⅠ,typeⅡ,typeⅢand typeⅣwas 36.7%,10.3%,42.4%and 10.6%,respectively.The diameter of 457(75.9%)thyroid extension was≤1 cm,the maximum diameter was 4.8 cm.Only 133(22.1%)of the thyroid extension could be detected pre-operatively by ultrasound.Conclusions Thyroid extension,as a common morphologic variation of thyroid,the size and relationship with thyroid of which vary greatly between individuals.