中国实用外科杂志

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全甲状腺切除在甲状腺良性结节治疗中应用及评价

张    浩   

  1. 中国医科大学附属第一医院普通外科教研室甲状腺外科,辽宁沈阳110001
  • 出版日期:2015-06-01 发布日期:2015-05-29

  • Online:2015-06-01 Published:2015-05-29

摘要:

甲状腺结节临床常见,尽管大部分为良性,但有手术指征时应行手术治疗,手术方式主要包括腺叶切除、甲状腺次全切除和全(近全)甲状腺切除等。甲状腺良性结节的手术方式目前尚存争议,若切除范围过小,结节复发风险增加,可能须再次手术;切除范围过大,则可能增加喉返神经损伤及甲状旁腺功能减退等并发症发生风险。全甲状腺切除因其能彻底切除病变,降低复发风险,避免再次手术,且并发症无明显增加,已成为国外治疗结节性甲状腺肿等良性甲状腺结节的首选术式。在我国,应综合考虑医生的技术水平、病人的个体情况及意愿等因素,可以考虑对具有手术指征的双叶甲状腺良性结节采用全甲状腺切除术。

关键词: 甲状腺结节, 全甲状腺切除术, 甲状腺次全切除术, 复发

Abstract:

Application and assessment of total thyroidectomy for benign thyroid nodules        ZHANG Hao. Department of General Surgery,the First Hospital of China Medical University,Shenyang 110001,China
Abstract    Thyroid nodule is a common disease in clinical practice. Although the majority of thyroid nodules have been found to be benign. Some of them need to be surgically excised when meeting the indications. The thyroid operations include lobectomy,subtotal thyroidectomy and total/near total thyroidectomy,etc. The preferred operation for benign thyroid nodules remains controversial. Less extensive resection may be related to a higher risk of recurrence. While more extensive resection may be associated with a higher risk of recurrent laryngeal nerve injury or hypoparathyroidism. Total thyroidectomy has been used to treat benign thyroid nodules for a long history. It is an operation that can be safely performed nowadays,with low incidence of permanent complications. It has been the optimal surgery that can prevent recurrence and avoid reoperation in cases of benign thyroid nodules such as multiple nodular goiter in foreign countries since a long time ago. It is also suggested to perform the operation in case of bilateral benign thyroid nodules with surgical indications given the different technical levels of surgeons and different situation of individual patient in China.

Key words: thyroid nodule, total thyroidectomy, subtotal thyroidectomy, recurrence