Marchesi M, Biffoni M, Tartaglia F, Biancari F, Campana F P
Third Department of Surgery, University La Sapienza, Policlinico Umberto I, Rome, Italy.
Int Surg. 1998 Jul-Sep;83(3):202-4.
The choice between subtotal and total thyroidectomy for multinodular goiter is controversial.
Subtotal and total thyroidectomy have been respectively performed in 108 and 451 euthyroid patients with multinodular goiter.
After subtotal and total thyroidectomy, transient recurrent laryngeal nerve (RLN) palsy occurred in 1 patient (0.9%) and 3 (0.6%), transient asymptomatic hypoparathyroidism in 27 (25%) and 131 (29%), and transient symptomatic hypoparathyroidism in 2 (1.8%) and 13 (2.9%), respectively (P = NS). After subtotal thyroidectomy, recurrence occurred in 27 patients (26%) Re-operation in 14 patients resulted in transient RLN palsy in 2 patients (14%), transient asymptomatic hypoparathyroidism in 6 (43 %) and transient symptomatic hypoparathyroidism in 2 (14%).
The failure to demonstrate any 'hormonal advantage' in preserving thyroid tissue by subtotal thyroidectomy, and the low morbidity rate and no need for re-operation after primary total thyroidectomy, make the latter the procedure of choice for the management of non-toxic multinodular goiter.
对于多结节性甲状腺肿，甲状腺次全切除术和全甲状腺切除术的选择存在争议。
分别对108例和451例甲状腺功能正常的多结节性甲状腺肿患者进行了甲状腺次全切除术和全甲状腺切除术。
甲状腺次全切除术和全甲状腺切除术后，暂时性喉返神经（RLN）麻痹分别发生在1例（0.9%）和3例（0.6%）患者中，暂时性无症状性甲状旁腺功能减退分别发生在27例（25%）和131例（29%）患者中，暂时性有症状性甲状旁腺功能减退分别发生在2例（1.8%）和13例（2.9%）患者中（P=无显著性差异）。甲状腺次全切除术后，27例患者（26%）出现复发。14例患者再次手术，导致2例患者（14%）出现暂时性RLN麻痹，6例（43%）出现暂时性无症状性甲状旁腺功能减退，2例（14%）出现暂时性有症状性甲状旁腺功能减退。
甲状腺次全切除术在保留甲状腺组织方面未显示出任何“激素优势”，且全甲状腺切除术后发病率低且无需再次手术，这使得全甲状腺切除术成为治疗非毒性多结节性甲状腺肿的首选手术方式。
