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目的探讨甲状腺腺瘤最佳手术方式。方法术前常规行血T3、T4、TSH检查,彩超检查,发现左侧腺瘤68例、右侧57例、双侧5例。分别施行甲状腺腺瘤摘除术、腺叶部分切除术、甲状腺次全切除术和腺叶切除术,术后病理均确诊为甲状腺腺瘤或伴囊性变。对136例手术治疗的甲状腺腺瘤患者进行随访,分析手术方式与术后复发的关系。结果获得随访130例,术后随访时间1～7年。发现17例腺瘤复发,单侧复发16例,双侧复发1例。复发时间2～5年,平均3年,其中腺瘤摘除术24例,复发6例(24%),腺叶部分切除41例,复发6例(14%),甲状腺次全切除20例,复发1例(5%),腺叶切除55例,无复发。结论甲状腺腺叶切除术是一种比较合理的手术方式,也是一种干净的手术方法,对于单发或多发腺瘤均可彻底切除,且对于术中冰冻切片证实是分化性甲状腺癌不会造成癌细胞的医源性播散。
Objective To investigate the best surgical method of thyroid adenoma. Methods Preoperative routine blood T3, T4, TSH examination, color Doppler ultrasound examination found that 68 cases of left adenoma, right 57 cases, bilateral 5 cases. Respectively, thyroid adenoma removal, partial glandular lobectomy, subtotal thyroidectomy and lobectomy, postoperative pathology were diagnosed as thyroid adenoma or cystic degeneration. Thirty-six patients with thyroid adenoma who underwent surgery were followed up and analyzed the relationship between the surgical procedure and postoperative recurrence. The results were followed up 130 cases, postoperative follow-up of 1 to 7 years. Adenomas recurrence was found in 17 cases, with 16 cases of unilateral recurrence and 1 case of bilateral recurrence. The recurrence time was 2 to 5 years, with an average of 3 years. There were 24 cases of adenoma removal, 6 cases of recurrence (24%), 41 cases of partial glandular lobectomy, 6 cases of recurrence (14%), 20 cases of subtotal thyroidectomy One case (5%), 55 cases of lobectomy, no recurrence. Conclusions Thyroid gland lobectomy is a reasonable surgical procedure and a clean operation method. It can be completely resected for single or multiple adenomas, and for the intraoperative frozen section confirmed that it is differentiated thyroid cancer does not cause Iatrogenic spread of cancer cells.