Erbil Yeşim, Barbaros Umut, Salmaslioğlu Artür, Yanik Burcu Tulumoğlu, Bozbora Alp, Ozarmağan Selçuk
Istanbul Medical Faculty, Department of General Surgery, Istanbul University, 34340, Capa, Istanbul, Turkey,
Langenbecks Arch Surg. 2006 Nov;391(6):567-73. doi: 10.1007/s00423-006-0091-z. Epub 2006 Sep 21.
In recent years, total or near-total thyroidectomy has emerged as a surgical option to treat patients with multinodular goiter, especially in endemic iodine-deficient regions. The aim of this study was to compare the complication rates of total and near-total thyroidectomy in multinodular goiter and the incidence of thyroid cancer requiring radioactive iodine ablation and completion thyroidectomy between groups.
Patients with euthyroid multinodular goiter without any preoperative suspicion of malignancy, history of familial thyroid cancer, or previous exposure to radiation were randomized (according to a random table) to total thyroidectomy (group 1, n = 104) and near-total thyroidectomy leaving less than 2 g (group 2, n = 112).
There were no persistent complications. The incidence of transient hypoparathyroidism in group 1 (26%) was significantly higher than in group 2 (9.8%) (p < 0.001). The rate of asymptomatic hypocalcemia in group 2 (7.4%) was lower than in group 1 (27%) (p < 0.001). The incidence of papillary cancer was 9.6% in group 1 and 12.5% in group 2 (p > 0.05). None of the patients underwent completion thyroidectomy before ablative therapy. Ten patients were found to have the histological criteria for radioactive iodine ablation. Of these 10 patients, four were in group 1 and six were in group 2 (p > 0.05).
In conclusion, we recommend near-total thyroidectomy in multinodular goiter instead of total or subtotal thyroidectomy. While near-total thyroidectomy and total thyroidectomy obviate the need for completion thyroidectomy in incidentally found thyroid cancer, and while there is no difference in the rate of recurrent laryngeal nerve palsy between the two methods, near-total thyroidectomy causes a significantly lower rate of hypoparathyroidism compared to total thyroidectomy.
近年来，甲状腺全切术或近全切术已成为治疗多结节性甲状腺肿患者的一种手术选择，尤其是在碘缺乏流行地区。本研究的目的是比较多结节性甲状腺肿患者甲状腺全切术和近全切术的并发症发生率，以及两组之间需要放射性碘消融和甲状腺补全切术的甲状腺癌发病率。
将甲状腺功能正常、术前无任何恶性肿瘤怀疑、无家族性甲状腺癌病史或既往无辐射暴露史的多结节性甲状腺肿患者（根据随机表）随机分为甲状腺全切术组（第1组，n = 104）和保留少于2 g甲状腺组织的近全切术组（第2组，n = 112）。
无持续性并发症。第1组暂时性甲状旁腺功能减退的发生率（26%）显著高于第2组（9.8%）（p < 0.001）。第2组无症状性低钙血症的发生率（7.4%）低于第1组（27%）（p < 0.001）。第1组乳头状癌的发生率为9.6%，第2组为12.5%（p > 0.05）。消融治疗前无患者接受甲状腺补全切术。发现10例患者符合放射性碘消融的组织学标准。在这10例患者中，4例在第1组，6例在第2组（p > 0.05）。
总之，我们建议多结节性甲状腺肿患者行近全切术而非全切术或次全切术。虽然近全切术和全切术可避免偶然发现的甲状腺癌患者进行甲状腺补全切术，且两种方法的喉返神经麻痹发生率无差异，但与全切术相比，近全切术导致甲状旁腺功能减退的发生率显著更低。
