甲状腺半切除术是良性结节性甲状腺肿的合理治疗方法吗？一项多中心回顾性单组研究。

Is hemithyroidectomy a rational management for benign nodular goitre? A Multicentre Retrospective Single Group Study.

作者信息

Attaallah W, Erel S, Canturk N Z, Erbil Y, Gorgulu S, Kulacoglu H, Kocdor M A, Kebudi A, Ozbas S, Gulluoglu B M

机构信息

Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey, Department of Surgery, Ankara Training and Research Hospital, Ankara, Turkey, Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey, Istanbul Faculty of Medicine, Surgery Unit E, Istanbul University, Istanbul, Turkey, Department of General Surgery, Gulhane Military Medical Academy, Ankara, Turkey, Department of Surgery, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey, Department of General Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey, Department of General Surgery, Maltepe University School of Medicine, Istanbul, Turkey, Department of General Surgery, Adnan Menderes University School of Medicine, Aydin, Turkey, *corresponding author: tel.: +90 2166570606, fax: +90 2166570695, email:

出版信息

Neth J Med. 2015 Jan;73(1):17-22.

PMID:26219937

Abstract

BACKGROUND

The incidence and potential risk factors for the recurrence of benign nodular goitre after unilateral thyroidectomy are not clearly defined. The aim of this study was to assess the rate of progression of nodular goitre in the contralateral thyroid lobe and of hypothyroidism requiring replacement therapy after unilateral thyroid lobectomy for benign nodular goitre.

PATIENTS AND METHODS

Patients who underwent hemithyroidectomy for benign nodular goitre between 2000 and 2009 were included in the study. The primary outcome of this study was the reoperation rate for recurrent goitre, the rate of progression of nodular goitre and the rate of hypothyroidism requiring L-T4 replacement therapy. Clinical factors that have an effect on progression were further analysed.

RESULTS

259 patients were included for study. Progression of the nodular goitre in the remnant lobe was observed in 32% (n = 83) of the patients. However, over time, only 2% of these 83 patients underwent contralateral hemithyroidectomy due to this progression. Fifty-six (22%) patients required L-thyroxin replacement due to persistent hypothyroidism after hemithyroidectomy. The factors shown to affect progression of nodular goitre were advanced age, preoperative hyperthyroidism, preoperative diagnosis of toxic nodular goitre and the presence of surgical indication for a toxic goitre causing hyperthyroidism and a definitive pathological diagnosis of nodular hyperplasia.

CONCLUSION

There was a progression of the nodular goitre in the remnant lobe in about one-third of the patients who underwent hemithyroidectomy. However, only 2% of these patients underwent complementary contralateral hemithyroidectomy due to clinical progression in 31 months of follow-up.

摘要

背景

单侧甲状腺切除术后良性结节性甲状腺肿复发的发生率及潜在危险因素尚不明确。本研究旨在评估良性结节性甲状腺肿单侧甲状腺叶切除术后对侧甲状腺叶结节性甲状腺肿的进展率以及需要替代治疗的甲状腺功能减退症的发生率。

患者与方法

纳入2000年至2009年间因良性结节性甲状腺肿接受甲状腺半切除术的患者。本研究的主要结局是复发性甲状腺肿的再次手术率、结节性甲状腺肿的进展率以及需要左甲状腺素替代治疗的甲状腺功能减退症的发生率。对影响进展的临床因素进行了进一步分析。

结果

259例患者纳入研究。32%（n = 83）的患者观察到残留叶结节性甲状腺肿有进展。然而，随着时间的推移，这83例患者中只有2%因这种进展接受了对侧甲状腺半切除术。56例（22%）患者因甲状腺半切除术后持续性甲状腺功能减退需要左甲状腺素替代治疗。显示影响结节性甲状腺肿进展的因素有高龄、术前甲状腺功能亢进、术前毒性结节性甲状腺肿诊断、毒性甲状腺肿导致甲状腺功能亢进的手术指征以及结节性增生的确切病理诊断。