Reoperation for The Recurrent Nodular Goiter in 48 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 孙学军 , 刘海涛 , 王树坤 ,  韩刚

解放军第89医院普外二科（山东潍坊 261021）;

Corresponding author：

韩刚, Email: 26779389@qq.com

Keywords：

结节性甲状腺肿; 复发; 甲状腺切除术

DOI：

10.7507/1007-9424.20140085

Video：

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目的探讨再次手术治疗复发性结节性甲状腺肿的安全性及有效性。方法回顾性分析2004年1月至2012年12月期间于笔者所在医院行再次手术治疗的48例复发性结节性甲状腺肿患者的临床资料。结果本组48例患者中，再次手术行甲状腺全切除术33例，行甲状腺近全切除术15例。术中显露喉返神经32例（61条），均无喉返神经损伤发生；未能显露喉返神经16例，其中有2例发生喉返神经损伤，损伤率为12.5%，高于显露喉返神经者（P＜0.05）。术后均无永久性低钙血症发生，17例（35.4%）发生暂时性低钙血症。术后均获访0.5～8.0年，平均4.3年，无复发。结论复发性结节性甲状腺肿再次手术行甲状腺全切除或近全切除术是安全可靠的，预防术后并发症的关键是熟悉甲状腺解剖和精细手术操作。

Citation： 孙学军, 刘海涛, 王树坤, 韩刚. Reoperation for The Recurrent Nodular Goiter in 48 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(3): 355-357. doi: 10.7507/1007-9424.20140085 Copy

1.	Zambudio AR, Rodríguez J, Riquelme J, et al. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery[J]. Ann Surg, 2004, 240(1):18-25.
2.	Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter:current status and future perspectives[J]. Endocr Rev, 2003, 24(1):102-132.
3.	高绪文, 李继莲.甲状腺疾病[M].北京:人民卫生出版社, 1999:80-88.
4.	刘荫华, 宋军民, 段学宁.结节性甲状腺肿合并甲亢的治疗现状[J].中国实用外科杂志, 2006, 26(7):492-495.
5.	Liu Q, Djuricin G, Prinz RA. Total thyroidectomy for benign thyroid disease[J]. Surgery, 1998, 123(1):2-7.
6.	王会元, 王晓辉, 李非, 等.甲状腺全切除术的适应证及安全性分析[J].中国普外基础与临床杂志, 2013, 20(4):427-431.
7.	Schmitz-Winnenthal FH, Schimmack S, Lawrence B, et al. Quality of life is not influenced by the extent of surgery in patients with benign goiter[J]. Langenbecks Arch Surg, 2011, 396(8):1157-1163.
8.	Thomusch O, Machens A, Sekulla C, et al. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery:a multivariate analysis of 5846 consecutive pati-ents[J]. Surgery, 2003, 133(2):180-185.
9.	Cavicchi O, Piccin O, Caliceti U, et al. Accuracy of PTH assay and corrected calcium in early prediction of hypoparathyroidism after thyroid surgery[J]. Otolaryngol Head Neck Surg, 2008, 138(5):594-600.
10.	刘木元, 杨熙鸿, 郭海鹏, 等.甲状腺全切除术的手术并发症分析[J].中国普通外科杂志, 2011, 20(11):1171-1174.
11.	曾志军, 欧迪鹏, 杨连粤.全甲状腺切除术手术指征、要点及并发症防治[J].中国实用外科杂志, 2010, 30(10):867-870.
12.	付占一.复发性结节性甲状腺肿93例手术治疗观察[J].中国煤炭工业医学杂志, 2012, 15(1):8-10.
13.	陆深泉, 刘涛.复发性结节性甲状腺肿再手术中预防喉返神经损伤的体会[J].中国普外基础与临床杂志, 2012, 19(7):777-778.
14.	杨卫平, 邵堂雷, 陈伟国, 等.甲状腺次全切除术后再行双侧全/近全切除术的探讨[J].中国实用外科杂志, 2009, 29(9):749-751.
15.	王永福, 陈建超.甲状腺手术中喉返神经损伤原因分析[J].中国普外基础与临床杂志, 2003, 10(3):229-229.
16.	董泾青, 雷尚通.甲状腺手术中显露喉返神经以避免喉返神经损伤的临床意义[J].中国普外基础与临床杂志, 2012, 19(3):297-299.
17.	武正炎.甲状腺和甲状旁腺疾病的外科治疗[J].外科理论与实践, 2005, 10(6):493-494.

1. Zambudio AR, Rodríguez J, Riquelme J, et al. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery[J]. Ann Surg, 2004, 240(1):18-25.
2. Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter:current status and future perspectives[J]. Endocr Rev, 2003, 24(1):102-132.
3. 高绪文, 李继莲.甲状腺疾病[M].北京:人民卫生出版社, 1999:80-88.
4. 刘荫华, 宋军民, 段学宁.结节性甲状腺肿合并甲亢的治疗现状[J].中国实用外科杂志, 2006, 26(7):492-495.
5. Liu Q, Djuricin G, Prinz RA. Total thyroidectomy for benign thyroid disease[J]. Surgery, 1998, 123(1):2-7.
6. 王会元, 王晓辉, 李非, 等.甲状腺全切除术的适应证及安全性分析[J].中国普外基础与临床杂志, 2013, 20(4):427-431.
7. Schmitz-Winnenthal FH, Schimmack S, Lawrence B, et al. Quality of life is not influenced by the extent of surgery in patients with benign goiter[J]. Langenbecks Arch Surg, 2011, 396(8):1157-1163.
8. Thomusch O, Machens A, Sekulla C, et al. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery:a multivariate analysis of 5846 consecutive pati-ents[J]. Surgery, 2003, 133(2):180-185.
9. Cavicchi O, Piccin O, Caliceti U, et al. Accuracy of PTH assay and corrected calcium in early prediction of hypoparathyroidism after thyroid surgery[J]. Otolaryngol Head Neck Surg, 2008, 138(5):594-600.
10. 刘木元, 杨熙鸿, 郭海鹏, 等.甲状腺全切除术的手术并发症分析[J].中国普通外科杂志, 2011, 20(11):1171-1174.
11. 曾志军, 欧迪鹏, 杨连粤.全甲状腺切除术手术指征、要点及并发症防治[J].中国实用外科杂志, 2010, 30(10):867-870.
12. 付占一.复发性结节性甲状腺肿93例手术治疗观察[J].中国煤炭工业医学杂志, 2012, 15(1):8-10.
13. 陆深泉, 刘涛.复发性结节性甲状腺肿再手术中预防喉返神经损伤的体会[J].中国普外基础与临床杂志, 2012, 19(7):777-778.
14. 杨卫平, 邵堂雷, 陈伟国, 等.甲状腺次全切除术后再行双侧全/近全切除术的探讨[J].中国实用外科杂志, 2009, 29(9):749-751.
15. 王永福, 陈建超.甲状腺手术中喉返神经损伤原因分析[J].中国普外基础与临床杂志, 2003, 10(3):229-229.
16. 董泾青, 雷尚通.甲状腺手术中显露喉返神经以避免喉返神经损伤的临床意义[J].中国普外基础与临床杂志, 2012, 19(3):297-299.
17. 武正炎.甲状腺和甲状旁腺疾病的外科治疗[J].外科理论与实践, 2005, 10(6):493-494.

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Reoperation for The Recurrent Nodular Goiter in 48 Cases

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