Ambrosi A, Pezzolla A, Barone G, Quaranta G, Errico D, Iacobone M, Ciampolillo A, Triggiani V
Cattedra di Chirurgia Generale Base, Università degli Studi di Bari.
Ann Ital Chir. 1994 Sep-Oct;65(5):543-6; discussion 546-7.
The different surgical chances for the treatment of non toxic nodular goiter led the Authors to study the residual function after partial thyroidectomy. A variable rate of recurrences and hormone deficiency was shown in patients who underwent sub-total thyroidectomy, lobectomy and enucleation. It depended on the amount of residual gland and the different methods they used. Recurrences occurred more in patients studied by ultrasonography. After sub-total thyroidectomy the Authors noted a more reduced number of recurrences than after lobectomy and enucleation. There was a meaningless connection between high plasmatic levels of TSH and recurrences. Subclinical hypothyroidism was higher in patients who underwent subtotal thyroidectomy than in patients treated with lobectomy and enucleation. These clinical data show that recurrences could depend on growth factors (EGF, IGF) in thyroid tissues and not only on TSH action. Therefore the surgical attitude of the authors in the treatment of nodular goiter consists in total thyroidectomy.
治疗非毒性结节性甲状腺肿的不同手术方式，促使作者研究甲状腺部分切除术后的残余功能。接受甲状腺次全切除术、叶切除术和摘除术的患者出现了不同比例的复发和激素缺乏情况。这取决于残余腺体的数量以及所采用的不同方法。超声检查发现复发情况在患者中更为常见。甲状腺次全切除术后，作者注意到复发数量比叶切除术和摘除术后更少。促甲状腺激素（TSH）血浆水平升高与复发之间存在无意义的关联。接受甲状腺次全切除术的患者亚临床甲状腺功能减退的发生率高于接受叶切除术和摘除术的患者。这些临床数据表明，复发可能取决于甲状腺组织中的生长因子（表皮生长因子、胰岛素样生长因子），而不仅仅取决于TSH的作用。因此，作者在治疗结节性甲状腺肿时的手术方式为甲状腺全切除术。
