Liu Q, Djuricin G, Prinz R A
Department of General Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill. 60612, USA.
Surgery. 1998 Jan;123(1):2-7.
The goal of this study was to evaluate the safety and efficacy of total thyroidectomy performed for benign thyroid disease.
A total of 106 consecutive patients undergoing total thyroidectomy for benign disease from October 1982 to July 1995 were reviewed. The 33 men and 73 women had an average age of 46 years (range, 16 to 82 years). Indications for total thyroidectomy were a thyroid nodule with the history of head and neck radiation in 36 patients, bilateral thyroid nodules in 35, needle biopsy of a follicular neoplasm or frozen section diagnosis of a possible malignancy in 18, and toxic goiter in 17. Total thyroidectomy was performed as the primary operation in 98 patients, and 8 patients had a completion reoperation for recurrent disease.
Pathology findings revealed benign nodular goiter in 49 patients, follicular adenoma in 26, hyperplasia in 19, and Hashimoto's thyroiditis in 12. Postoperative hemorrhage requiring operative hemostasis occurred in two patients (1.9%). Two patients had unilateral recurrent laryngeal nerve (RLN) palsy before operation (1.9%). Three patients had unilateral postoperative RLN palsy (2.8%). Two cases resolved in 3 and 4 months. The only permanent RLN injury occurred in a patient reoperated for a compressive goiter. Early postoperative hypocalcemia (8.0 mg/dl or less) was found in nine patients (8.5%). No patient had permanent hypoparathyroidism at long-term follow-up evaluation.
Total thyroidectomy for benign thyroid disease can avoid reoperation for nodular goiter and hyperthyroidism and eliminate any subsequent risk of malignant change in radiated thyroid glands. A low complication rate can be achieved with meticulous surgical technique. Total thyroidectomy can be performed safely for bilateral benign thyroid disease.
本研究的目的是评估因良性甲状腺疾病行甲状腺全切除术的安全性和有效性。
回顾了1982年10月至1995年7月期间连续106例行甲状腺全切除术治疗良性疾病的患者。其中33例男性和73例女性，平均年龄46岁（范围16至82岁）。甲状腺全切除术的指征为：36例有头颈部放疗史的甲状腺结节患者，35例双侧甲状腺结节患者，18例经针吸活检为滤泡性肿瘤或冰冻切片诊断可能为恶性肿瘤的患者，以及17例毒性甲状腺肿患者。98例患者将甲状腺全切除术作为初次手术，8例患者因复发性疾病接受了再次手术。
病理检查结果显示，49例为良性结节性甲状腺肿，26例为滤泡性腺瘤，19例为增生，12例为桥本甲状腺炎。2例患者（1.9%）术后出血需要手术止血。2例患者术前有单侧喉返神经麻痹（1.9%）。3例患者术后出现单侧喉返神经麻痹（2.8%）。2例在3个月和4个月后恢复。唯一的永久性喉返神经损伤发生在1例因压迫性甲状腺肿接受再次手术的患者身上。9例患者（8.5%）术后早期出现低钙血症（血钙浓度≤8.0mg/dl）。长期随访评估中无患者发生永久性甲状旁腺功能减退。
因良性甲状腺疾病行甲状腺全切除术可避免结节性甲状腺肿和甲状腺功能亢进的再次手术，并消除放射性甲状腺发生恶性变的任何后续风险。通过细致的手术技术可实现较低的并发症发生率。双侧良性甲状腺疾病行甲状腺全切除术可安全进行。
