儿童和青少年Graves病手术治疗的疗效及预后分析

Therapeutic effect and prognosis of surgical treatment of infant and adolescent Graves Disease

目的 探讨手术治疗儿童和青少年Graves病的疗效及影响因素。方法 回顾性分析 1990～ 2 0 0 2年手术并病理证实的儿童和青少年Graves病 65例的临床资料 ,全组病例行甲状腺次全切除术 ,其中 42例以微创方法完成手术 ,残留腺体 3～ 4g。随访指标 :临床症状和体征 ,T3 ,T4,BMR。结果 本组无手术死亡和相关死亡 ,暂时性声带麻痹8例 (1.2 5 % ) ,症状半年内消失 ,一过性低钙血症 6例 (0 .91% ) ,经处理后症状 3d内消失。 5 7例 (87.70 % )获得随访 6个月～ 10年 ,无永久性声带麻痹和低钙血症 ,病人生长发育恢复正常 ,情绪稳定 ,学习成绩提高 ,18例突眼中 15例(83 .3 3 % )症状改善 ,2年内 7例 (12 .3 % )有甲状腺功能低下 ,3年内全部甲低病例自愈 ;3例 4年内症状复发 ,其中 2例再手术痊愈。结论 外科治疗儿童和青少年Graves病疗效肯定 ,迅速 ,持久 ,费用低 ,有利于青少年生长发育和学习 。

Objective To evaluate the therapeutic effects and prognosis of surgical treatment of Graves' disease in chlidren and adolescence. Methods A retrospective study was performed in 65 patients of children and adolescence treated by surgery from 1990～2002.Subtotal bilateral thyroidectomy was done in all cases.Weight of remnant tissue was between 3～4g.Pre-and post operation status were studies. Results There was no operative and relative mortality in this group.Surgical complications were 8(1.25%) vocal cord palsies and 6(0.91%) hypocalcemia.After a follow-up,they were no longer any cases of vocal cord dysfunction and no case of permnanent hypoparathyridism.57 cases were followed up peried ranged from 6 months to 10 years.7 patients had hypothyroidism(12.3%) within first 2 years and 3 had recurrent hyperthyroidism (5.26%) within first 4 years and others had euthyroidism.All patients were nomotrophic both physically and mentally. Conclusion The authors came to the conclusion that Subtotal bilateral thyroidectomy applied in children and adolescence hyperthyroidism could achieve a swift,consistent,safe,and effective recovery.