因良性甲状腺疾病行全甲状腺切除术。

Total thyroidectomy for benign thyroid disease.

作者信息

Friguglietti Celso U M, Lin Chin S, Kulcsar Marco A V

机构信息

Division of Head and Neck Surgery, Brazilian Institute of Cancer Control, Santo Amaro University, Avenue Paulista 1159, Room J.1514, São Paulo, Brazil.

出版信息

Laryngoscope. 2003 Oct;113(10):1820-6. doi: 10.1097/00005537-200310000-00030.

DOI:10.1097/00005537-200310000-00030

PMID:14520113

Abstract

OBJECTIVES/HYPOTHESIS: The use of total thyroidectomy in thyroid cancer treatment is not unanimous, and it is even more controversial when this procedure is advocated for benign diseases. On the other hand, the complication risk may have an increase up to 20 times in repeat operations for recurrence. The objective of the study was to evaluate the use of total thyroidectomy in benign diseases, multinodular goiter, and Graves disease to justify the authors' preference.

STUDY DESIGN

Retrospective study of use of total thyroidectomy in benign diseases.

METHODS

Retrospective study of 1789 patients who underwent thyroidectomies from June 1990 to December 2000. Indication, extension of thyroidectomy, cancer incidence, and complications were analyzed.

RESULTS

Total thyroidectomy was performed in 81.19% of 456 patients with nontoxic multinodular goiter, 93.93% of 33 with toxic multinodular goiter, 93.93% of 66 with recurrent multinodular goiter, and 49.18% of 122 with Graves disease. Thyroid cancer was found in 16.62%, 9.09%, 3.03% and 5.73% of patients, respectively. Transitory and permanent hypoparathyroidism, hematoma requiring surgical intervention, and transitory and permanent recurrent laryngeal nerve injury occurred in 12.27%, 1.61%, 0.26%, 1.88%, and 0.35% of the patients undergoing total thyroidectomy, respectively. Permanent complications of total thyroidectomy for nontoxic multinodular goiter and Graves disease were similar to nontotal thyroidectomy. Use of total thyroidectomy for nontoxic multinodular goiter increased from 53.33% of the patient to 81.19%, on average, with a concomitant increase of cancer diagnosis from 11.11% to 16,62%. The authors performed total thyroidectomy for all patients with Graves disease.

CONCLUSION

Total thyroidectomy is the treatment of choice for multinodular goiter and thyroiditis, when there is bilateral gland involvement posterior to middle thyroid veins, and for Graves disease because it decreases the likelihood of future repeat operations for recurrent disease and thus the associated risks, when performed safely.

摘要

目的/假设：甲状腺癌治疗中全甲状腺切除术的应用尚无定论，而对于良性疾病提倡采用该手术时争议更大。另一方面，复发再次手术时并发症风险可能增加多达20倍。本研究的目的是评估全甲状腺切除术在良性疾病、结节性甲状腺肿和格雷夫斯病中的应用，以证明作者的偏好是合理的。

研究设计

对全甲状腺切除术在良性疾病中的应用进行回顾性研究。

方法

对1990年6月至2000年12月期间接受甲状腺切除术的1789例患者进行回顾性研究。分析手术指征、甲状腺切除术范围、癌症发病率和并发症情况。

结果

456例非毒性结节性甲状腺肿患者中81.19%接受了全甲状腺切除术，33例毒性结节性甲状腺肿患者中93.93%接受了该手术，66例复发性结节性甲状腺肿患者中93.93%接受了该手术，122例格雷夫斯病患者中49.18%接受了该手术。甲状腺癌分别在16.62%、9.09%、3.03%和5.73%的患者中被发现。全甲状腺切除术患者中，暂时性和永久性甲状旁腺功能减退、需要手术干预的血肿以及暂时性和永久性喉返神经损伤的发生率分别为12.27%、1.61%、0.26%、1.88%和0.35%。非毒性结节性甲状腺肿和格雷夫斯病行全甲状腺切除术的永久性并发症与非全甲状腺切除术相似。非毒性结节性甲状腺肿行全甲状腺切除术的比例从患者的53.33%平均增至81.19%，同时癌症诊断率从11.11%增至16.62%。作者对所有格雷夫斯病患者均实施了全甲状腺切除术。