CAJ | 학술논문

目的对比甲状腺全切除术(TT)与甲状腺近/次全切除术(S/NT)术中甲状旁腺显露、术后病理及并发症，评价其安全性和优劣性。方法采用显微视野下精细化解剖技术对2006年12月至2009年12月汕头大学医学院附属肿瘤医院收治的278例甲状腺双侧多发结节随机行TT和S/NT，观察其术中甲状旁腺显露、术后病理及并发症。结果术前诊断良性227例，术后病理诊断灶性癌变28例(12.3％)；术中甲状旁腺显露率：TT组96.5％，S/NT组60.4％,P＜0.05；术后平均血钙浓度：TT组(2.057±0.016) mmol/L，S/NT组(2.215 +0.019) mmol/L,P＜0.05；术后暂时性甲状旁腺功能减退发生率：TT组16.9％，S/NT组5.7％，P ＜0.05；其他术后并发症如永久性甲状旁腺功能减退、喉返神经麻痹等发生率，2组差异无统计学意义；TT组中二次手术组术后永久性甲状旁腺功能减退发生率为11.1％，初治手术组0.0％，P＜0.05。结论在显微视野下精细化解剖的基础上，TT是甲状腺双侧多发结节初治患者安全有效的手术方式。
목적 대비갑상선전절제술(TT)여갑상선근/차전절제술(S/NT)술중갑상방선현로、술후병리급병발증，평개기안전성화우렬성。방법채용현미시야하정세화해부기술대2006년12월지2009년12월산두대학의학원부속종류의원수치적278례갑상선쌍측다발결절수궤행TT화S/NT，관찰기술중갑상방선현로、술후병리급병발증。결과술전진단량성227례，술후병리진단조성암변28례(12.3％)；술중갑상방선현로솔：TT조96.5％，S/NT조60.4％,P＜0.05；술후평균혈개농도：TT조(2.057±0.016) mmol/L，S/NT조(2.215 +0.019) mmol/L,P＜0.05；술후잠시성갑상방선공능감퇴발생솔：TT조16.9％，S/NT조5.7％，P ＜0.05；기타술후병발증여영구성갑상방선공능감퇴、후반신경마비등발생솔，2조차이무통계학의의；TT조중이차수술조술후영구성갑상방선공능감퇴발생솔위11.1％，초치수술조0.0％，P＜0.05。결론재현미시야하정세화해부적기출상，TT시갑상선쌍측다발결절초치환자안전유효적수술방식。
Objective To compare the exposure, identification of parathyroid and postoperative complications between total thyroidectomy (TT) and subtotal/near total thyroidectomy (S/NT) for bilateral multiple thyroid nodules. Methods A total of 278 cases were performed TT and S/NT randomly from Dec. 2006 to Dec.2009. The histology, identification of parathyroid and recurrent laryngeal nerves (RLN), and incidence of complications were compared between the 2 surgical procedures. The data were processed with t test or x2 test.Results 227 cases were estimated to be benign preoperatively, among whom 28 cases ( 12.3％ ) were diagnosed as focal cancer by postoperative pathology. The identification rate of parathyroid was 96.5％ in TT group and 60.4％ in S/NT group (P＜0.05). The mean postoperative serum calcium level was 2.057 +0.016 mmol/L in TT group and 2. 15 + 0.019 mmol/L in S/NT group (P ＜ 0.05 ). The incidence rate of transient hypoparathyroidism (HPT) was 16.9％ in TT group and 5.7％ in S/NT group (P＜0.05). There was no statistical difference between the 2 groups in terms of the incidence rate of permanent HPT and transient recurrent laryngeal nerves (RLN) palsy ( P ＞ 0.05 ). The incidence rate of permanent HPT was higher in reoperation cases ( 11.1％ ) than in primary surgery cases (0.0％) in TT group ( P ＜0.05 ). Conclusion Based on the accurate technique under microscope field, TT is a safe surgical procedure for primary surgery with bilateral multiple thyroid nodules.