De Toma G, Tedesco M, Gabriele R, Campli M, Plocco M, Borghese M, Letizia C
I Clinica Chirurgica, Università degli Studi La Sapienza, Roma.
G Chir. 1995 Aug-Sep;16(8-9):373-6.
The Authors report their experience in the management of 201 patients with multinodular toxic goiter (MTG): 122 (60.7%) underwent subtotal thyroidectomy (STT), while 79 (39.3%) underwent total thyroidectomy (TT). Through a retrospective study the patients were stratified into two groups according to the type of operation (TT or STT). Overall, neither operative mortality nor recurrent nerve damage were encountered. Permanent hypocalcemia was observed in 7 patients (5.7%) who underwent STT and in 6 patients (7.5%) who underwent TT (p=N.S.), while transitory hypocalcemia was observed in 12 cases (9.8%) in group I and 11 cases (13.9%) in group II (p=N.S.). All patients were followed every 4 months for the first year and every 6 months thereafter. Average and median follow-up period were, respectively, 72 and 74 months. The Authors conclude that total thyroidectomy is the surgical treatment of choice in multinodular toxic goiter (MTG). A thorough anatomical-surgical evaluation is essential in order to prevent the complications characteristic of this type of surgery (inferior laryngeal nerve injury and hypoparathyroidism).
作者报告了他们对201例多结节性毒性甲状腺肿（MTG）患者的治疗经验：122例（60.7%）接受了甲状腺次全切除术（STT），而79例（39.3%）接受了甲状腺全切除术（TT）。通过回顾性研究，根据手术类型（TT或STT）将患者分为两组。总体而言，未出现手术死亡率和喉返神经损伤情况。接受STT的7例患者（5.7%）和接受TT的6例患者（7.5%）出现永久性低钙血症（p=无统计学意义），而I组12例患者（9.8%）和II组11例患者（13.9%）出现暂时性低钙血症（p=无统计学意义）。所有患者在第一年每4个月随访一次，此后每6个月随访一次。平均随访期和中位随访期分别为72个月和74个月。作者得出结论，甲状腺全切除术是多结节性毒性甲状腺肿（MTG）的首选手术治疗方法。为预防此类手术的典型并发症（喉返神经损伤和甲状旁腺功能减退），进行全面的解剖学手术评估至关重要。
