Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University College of Medicine, 37 Pradnicka Street, 31-202, Kraków, Poland.
World J Surg. 2010 Jun;34(6):1203-13. doi: 10.1007/s00268-010-0491-7.
The extent of thyroid resection in multinodular nontoxic goiter (MNG) is controversial. The aim of the present study was to evaluate results of various thyroid resection modes, with special emphasis put on the recurrence rate and morbidity rate, in a 5-year follow-up.
From 01/2000 through 12/2003, 600 consenting patients with MNG qualified for thyroidectomy at our institution were randomized to three groups equal in size, n = 200 in each. Patients in group A underwent total thyroidectomy (TT); patients in group B underwent Dunhill operation (DO), whereas patients in group C underwent bilateral subtotal thyroidectomy (BST). All patients were subjected to ultrasonographic, cytological, and biochemical follow-up at least for 60 months postoperatively. The primary outcome measure was prevalence of recurrent goiter and need for redo surgery. The secondary outcome measure was the postoperative morbidity rate (hypoparathyroidism and recurrent laryngeal nerve injury).
Recurrent goiter was found in 0.52% TT versus 4.71% DO versus 11.58% BST (p = 0.01 for TT versus DO, p = 0.02 for DO versus BST, p < 0.001 for TT versus BST), and completion thyroidectomy was necessary in 0.52% TT versus 1.57% DO versus 3.68% BST (p = 0.03 for TT versus BST). Transient postoperative hypoparathyroidism was present in 10.99% versus 4.23% versus 2.1% (p = 0.007 for TT versus DO, p < 0.001 for TT versus BST), whereas the recurrent laryngeal nerve injury rate was 5.49% and 1.05% TT versus 4.23% and 0.79% DO versus 2.1% and 0.53% BST (transient and permanent, respectively; p = 0.007 for transient events TT versus BST).
Total thyroidectomy can be regarded as the procedure of choice for patients with MNG. It is associated with a significantly lower incidence of goiter recurrence and less frequent need for completion thyroidectomy than other more limited thyroid resections. However, TT involves a significantly higher risk of postoperative transient but not permanent hypoparathyroidism and recurrent laryngeal nerve paresis.
甲状腺切除术治疗多发性结节性非毒性甲状腺肿（MNG）的范围仍存在争议。本研究的目的是评估各种甲状腺切除术式在 5 年随访中的结果，特别关注复发率和发病率。
自 2000 年 1 月至 2003 年 12 月，在我们机构有 600 例符合甲状腺切除术条件的 MNG 患者同意参加研究，随机分为三组，每组 200 例。A 组患者行甲状腺全切除术（TT）；B 组患者行 Dunhill 手术（DO）；C 组患者行双侧甲状腺次全切除术（BST）。所有患者术后均至少接受 60 个月的超声、细胞学和生化随访。主要观察指标为复发性甲状腺肿的发生率和再次手术的需要。次要观察指标为术后发病率（甲状旁腺功能减退和喉返神经损伤）。
TT 组、DO 组和 BST 组的复发性甲状腺肿发生率分别为 0.52%、4.71%和 11.58%（TT 组与 DO 组比较，p=0.01；DO 组与 BST 组比较，p=0.02；TT 组与 BST 组比较，p<0.001），需要再次甲状腺切除术的比例分别为 0.52%、1.57%和 3.68%（TT 组与 BST 组比较，p=0.03）。TT 组、DO 组和 BST 组术后暂时性甲状旁腺功能减退发生率分别为 10.99%、4.23%和 2.1%（TT 组与 DO 组比较，p=0.007；TT 组与 BST 组比较，p<0.001），喉返神经损伤发生率分别为 5.49%、1.05%、4.23%和 0.79%（暂时性和永久性，分别为 TT 组与 DO 组比较，p=0.007）。
甲状腺全切除术可作为 MNG 患者的首选术式。与其他更有限的甲状腺切除术相比，其甲状腺肿复发发生率较低，需要再次甲状腺切除术的可能性较小。然而，TT 术后发生暂时性但不是永久性甲状旁腺功能减退和喉返神经麻痹的风险显著增加。
