甲状腺功能亢进症术后复发的再手术治疗:附34例报告

Reoperation for postoperative recurrence of hyperthyroidism:a report of 34 cases

目的 探讨甲状腺功能亢进症 (甲亢 )术后复发的原因 ,再手术治疗的适应证及手术方法。方法 回顾性分析 3 4例甲亢术后复发再手术治疗的临床资料。结果 再次手术术式包括双侧甲状腺次全切除 2 9例 ,单侧腺叶切除 5例。全部治愈。并发症发生率 5 .9% ,与笔者收治的同期甲亢初次手术比较无统计学差异。全组经随访 1～ 10年 ,无甲亢再复发或甲状腺功能低下者。结论 腺体残留过多是甲亢术后复发的主要原因 ,有选择地再手术是甲亢术后复发较好的治疗方法。术中仔细解剖可避免损伤喉返神径和甲状旁腺 ,以及预防大出血的发生。

Objective To investigate the causes, the indications and operative procedures of reoperation for postoperative recurrence of hyperthyroidism. Method Clinical data of 34 cases of postoperative recurrence of hyperthyroidism received reoperation were analyzed retrospectively .Results The reoperative procedures including bilateral subtotal thyroidectomy in 29 cases, unilateral thyroidectomy in 5. All the 34 patients were cured by reoperation.The incidence of postoperative complication was 5.9%,which was not significantly different compared with primary operation treatment during the same time in our hospital.All the 34 case were followed up for 1～10 years,the results showed that all patients were alive well without recurrence or hypothyroidism .Conclusions Extension of the resected thyoid is not enough in the primary surgery is the main cause of postoperative recurrence of hyperthyroidism.Reoperation is the choise of therapy in selective patients with postoperative hyperthyroidsm recurrence .Careful intraoperative dissection can help to avoid injuries of recurrent nerve and parathyroid,and to prevent massive bleeding.