Barakate Michael S, Agarwal Gaurav, Reeve Tom S, Barraclough Bruce, Robinson Bruce, Delbridge Leigh W
University of Sydney Endocrine Surgical Unit, Department of Surgery, Australia.
ANZ J Surg. 2002 May;72(5):321-4. doi: 10.1046/j.1445-2197.2002.02400.x.
Subtotal thyroidectomy has been advocated as the standard treatment for Graves' disease because of the possibility of avoiding thyroxine therapy as well as the assumed lower risk of complications compared to total thyroidectomy. However, the long-term results of subtotal thyroidectomy are not as good as they were previously believed to be, as evidenced by the increasing incidence of hypothyroidism. If the risk of complications from total thyroidectomy is no higher,then that procedure offers significant advantages in the surgical management of Graves' disease. The aim of this study therefore was to compare the complication rate of the two procedures in patients with Graves' disease.
This was a retrospective case control study in a tertiary referral hospital. Information was obtained from an endocrine surgery database over the study period from January 1957 to December 2000. During that period 1246 patients with Graves' disease underwent subtotal thyroidectomy and 119 patients underwent total thyroidectomy.
Prior to 1987 total thyroidectomy was rarely if ever performed whereas in the last 12 months total thyroidectomy comprised 95% of all procedures. There was no significant difference in the rate of permanent complications between the two procedures although temporary hypocalcaemia was significantly more common following total thyroidectomy. Permanent hypoparathyroidism resulted in one patient each who underwent total thyroidectomy (0.8%) and subtotal thyroidectomy (0.1%). Permanent recurrent laryngeal nerve palsy occurred in one patient who underwent total thyroidectomy (0.8%) and 5 patients undergoing subtotal thyroidectomy (0.4%).
Given that subtotal thyroidectomy provides an unpredictable outcome and that the risk of permanent complications is no greater than with total thyroidectomy, there appears little logical reason to continue to recommend subtotal thyroidectomy for the surgical management of Graves' disease. We believe that Graves' disease should join the increasing list of thyroid conditions for which total thyroidectomy is the preferred option.
由于甲状腺次全切除术有可能避免甲状腺素治疗，且与甲状腺全切除术相比并发症风险假定较低，因此一直被倡导作为格雷夫斯病的标准治疗方法。然而，甲状腺次全切除术的长期效果并不像之前认为的那么好，甲状腺功能减退症发病率的上升就证明了这一点。如果甲状腺全切除术的并发症风险并不更高，那么该手术在格雷夫斯病的外科治疗中具有显著优势。因此，本研究的目的是比较格雷夫斯病患者这两种手术的并发症发生率。
这是一项在三级转诊医院进行的回顾性病例对照研究。研究期间为1957年1月至2000年12月，信息从内分泌外科数据库中获取。在此期间，1246例格雷夫斯病患者接受了甲状腺次全切除术，119例患者接受了甲状腺全切除术。
1987年以前很少进行甲状腺全切除术，而在最后12个月中，甲状腺全切除术占所有手术的95%。两种手术的永久性并发症发生率没有显著差异，尽管甲状腺全切除术后暂时性低钙血症明显更常见。永久性甲状旁腺功能减退症在接受甲状腺全切除术的患者中有1例（0.8%），接受甲状腺次全切除术的患者中有1例（0.1%）。永久性喉返神经麻痹在接受甲状腺全切除术的患者中有1例（0.8%），接受甲状腺次全切除术的患者中有5例（0.4%）。
鉴于甲状腺次全切除术的结果不可预测，且永久性并发症风险并不高于甲状腺全切除术，继续推荐甲状腺次全切除术用于格雷夫斯病的外科治疗似乎没有什么合理的理由。我们认为，格雷夫斯病应加入越来越多的甲状腺疾病行列，对于这些疾病，甲状腺全切除术是首选方案。
