Francomano F, Cotellese R, Scipione P, Ricci A, Ricciardi A, Napolitano L, Scurti D
Istituto di Patologia Chirurgica, Università degli Studi di Chieti.
Ann Ital Chir. 1994 Nov-Dec;65(6):677-81.
The most important problems of hyperthyroidism surgery are: the correct indication of operation, the choice of the best moment for operation and at last the extension of the resection. The authors experience include 365 patients with hyperthyroidism; 201 of them had monolateral autonomous nodules, 82 had diffuse multinodular goitre and 79 had Graves disease. In the first group of patients surgical treatment was total extracapsular isthmo-lobectomy, in the second group was performed subtotal thyroidectomy and in the third group was almost performed near-total thyroidectomy. Three relapses were found: two of that regarded patients with autonomous function nodule and one in patient with Graves disease. In 201 patients with toxic monolateral hyperfunction of the node, an extracapsular isthmo-lobectomy was performed. In the greater part of the 82 multinodular goiter cases a sub-total thyroidectomy was performed, as well as in 79 patients with Graves disease. Among the 3 recidive cases of hyperthyroidism (0.8%) one was recorded in a patient with Graves disease, (after subtotal thyroidectomy) and two in patients with hyperfunction of the node, (after isthmo-lobectomy). The authors justify the low incidence of recurrence by the choice of large extension of resection without a great number of complications.
正确的手术指征、最佳手术时机的选择以及最后的切除范围。作者的经验包括365例甲状腺功能亢进症患者；其中201例有单侧自主性结节，82例有弥漫性多结节性甲状腺肿，79例有格雷夫斯病。第一组患者的手术治疗是全囊外峡部甲状腺叶切除术，第二组进行甲状腺次全切除术，第三组几乎进行近全甲状腺切除术。发现3例复发：其中两例是有自主功能结节的患者，1例是格雷夫斯病患者。对201例有结节性单侧毒性功能亢进的患者进行了囊外峡部甲状腺叶切除术。在82例多结节性甲状腺肿病例中的大部分以及79例格雷夫斯病患者都进行了甲状腺次全切除术。在3例甲状腺功能亢进症复发病例（0.8%）中，1例是格雷夫斯病患者（甲状腺次全切除术后），2例是结节功能亢进患者（峡部甲状腺叶切除术后）。作者通过选择大范围切除且并发症较少来解释低复发率。
