Dunhill术与双侧甲状腺次全切术治疗双侧结节性甲状腺肿的效果比较

    Comparison of the effects between Dunhill surgery and bilateral subtotal thyroidectomy in the treatment of bilateral nodular goiter

    • 摘要:
      目的探讨Dunhill术与双侧甲状腺次全切术治疗双侧结节性甲状腺肿(NG)的效果及对预后的影响。
      方法选取120例双侧NG病人,依据手术方式不同分为Dunhill术组(55例)和双侧次全切术组(65例);比较2组手术时间、术中出血量、留置引流时间、引流量及住院时间等手术相关指标,以及并发症发生率、复发情况;采用化学发光法检测2组手术前后的游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平、血清促甲状腺激素(TSH)水平。
      结果Dunhill术组手术时间明显长于双侧次全切术组(P < 0.01);手术前及手术后,2组的TSH、FT3、FT4水平比较差异均无统计学意义(P>0.05);Dunhill术组的低血钙症发生率14.55%高于双侧次全切术组的1.54%(P < 0.05),2组在声音嘶哑、喉返神经损伤、手足麻木及甲状腺功能低下发生率方面比较差异均无统计学意义(P>0.05);Dunhill术组的复发率低于双侧次全切术组(P < 0.05)。
      结论Dunhill术与双侧甲状腺次全切术治疗结节性甲状腺肿疗效相当,但Dunhill术更加能够兼顾有效性与安全性,降低术后复发率。

       

      Abstract:
      ObjectiveTo investigate the curative effects of Dunhill surgery and bilateral subtotal thyroidectomy in the treatment of bilateral nodular goiter(NG), and its effects on prognosis.
      MethodsThe clinical data of 120 bilateral NG patients were retrospectively analyzed, and the patients were divided into the Dunhill surgery group(55 cases) and bilateral subtotal thyroidectomy group(65 cases) according to different surgical methods.The operation time, intraoperative blood loss, indwelling drainage time, drainage volume, hospitalization time, and incidence rates of complication and recurrence were compared between two groups.The levels of free triiodothyronine(FT3), free thyroxine(FT4) and serum thyroid stimulating hormone(TSH) in two groups before and after surgery were detected using chemiluminescence method.
      ResultsThe operation time in Dunhill surgery group was significantly longer than that in bilateral subtotal thyroidectomy group(P < 0.01).The differences of the levels of TSH, FT3 and FT4 before and after surgery between two groups were not statistically significant(P>0.05).The incidence rate of hypocalcemia in Dunhill surgery group was higher than that in bilateral subtotal thyroidectomy group(14.55% vs 1.54%)(P < 0.05).The differences of the incidence rates of hoarseness, recurrent laryngeal nerve injury, hand and foot numbness and hypothyroidism were not statistically significant between two groups(P>0.05).The recurrence rate in Dunhill surgery group was lower than that in bilateral subtotal thyroidectomy group(P < 0.05).
      ConclusionsDunhill surgery has the same effect as bilateral subtotal thyroidectomy in the treatment of nodular goiter.However, Dunhill surgery can better balance the efficacy and safety, and reduce postoperative recurrence rate.

       

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