Dunhill手术治疗双侧结节性甲状腺肿的临床疗效分析
| 作者: |
1任海洋,
1吕浩强,
1冯伟,
1金鑫,
1周健,
1张金梁,
1徐力善,
1翟博
1 哈尔滨医科大学附属第四医院 肿瘤、肝胆外科，哈尔滨 150001 |
| 通讯: |
翟博
Email: 15146126688@126.com |
| DOI: | 10.3978/.2018.05.010 |
| 基金: | 国家自然科学基金资助项目（81401975）；黑龙江省自然科学基金资助项目（H2018028）；黑龙江省医学科学院科研计划资助项目（201502，201815）。 |
摘要
目的：探讨Dunhill手术（一侧甲状腺全切加对侧次全切除术）治疗双侧结节性甲状腺肿的临床效果。
方法：收集哈尔滨医科大学附属第四医院2011年1月—2017年1月间开展的58例Dunhill手术与60例双侧甲状腺次全切除术的患者临床资料进行回顾性分析，所有患者术中病理均证实为双侧结节性甲状腺肿。
结果：两组患者术前一般资料均无统计学差异（均P>0.05）。与双侧次全切除术组比较，Dunhill手术组的平均手术时间明显延长（95.41 min vs. 52.48 min，P=0.000），术后第1天低血钙发生率明显升高（12.1% vs. 1.7%，P=0.031），两组术中出血量、甲状旁腺移植例数、喉返神经损伤发生率、术后第3天低钙血症发生率、甲状旁腺功能低下发生率均无统计学差异（P=1.000）。随访期间，Dunhill手术组患者复发率明显低于双侧甲状腺次全切除术组患者（P=0.027）。
结论：Dunhill手术治疗双侧结节性甲状腺肿安全、有效，且能有效降低术后复发，推荐其临床应用。
关键词：
甲状腺肿，结节性；甲状腺切除术；手术后并发症；复发
方法：收集哈尔滨医科大学附属第四医院2011年1月—2017年1月间开展的58例Dunhill手术与60例双侧甲状腺次全切除术的患者临床资料进行回顾性分析，所有患者术中病理均证实为双侧结节性甲状腺肿。
结果：两组患者术前一般资料均无统计学差异（均P>0.05）。与双侧次全切除术组比较，Dunhill手术组的平均手术时间明显延长（95.41 min vs. 52.48 min，P=0.000），术后第1天低血钙发生率明显升高（12.1% vs. 1.7%，P=0.031），两组术中出血量、甲状旁腺移植例数、喉返神经损伤发生率、术后第3天低钙血症发生率、甲状旁腺功能低下发生率均无统计学差异（P=1.000）。随访期间，Dunhill手术组患者复发率明显低于双侧甲状腺次全切除术组患者（P=0.027）。
结论：Dunhill手术治疗双侧结节性甲状腺肿安全、有效，且能有效降低术后复发，推荐其临床应用。
Efficacy analysis of Dunhill operation for bilateral multinodular goiter
CorrespondingAuthor:ZHAI Bo Email: 15146126688@126.com
Abstract
Objective: To investigate the clinical efficacy of Dunhill operation (hemithyroidectomy plus contralateral subtotal resection) in treatment of bilateral multinodular goiter.
Methods: The clinical data of 58 patients undergoing Dunhill operation and 60 patients undergoing bilateral subtotal thyroidectomy from January 2011 to January 2017 in the Fourth Affiliated Hospital of Harbin Medical University were retrospectively analyzed. All patients were confirmed to have bilateral multinodular goiter by intraoperative pathological diagnosis.
Results: The preoperative data showed no significant difference between the two groups of patients (all P>0.05). In Dunhill operation group compared with bilateral subtotal thyroidectomy group, the average operative time was significantly prolonged (95.41 min vs. 52.48 min, P=0.000) and the incidence of hypocalcemia on the first postoperative day was significantly increased (12.1% vs. 1.7%, P=0.031), while there were no significant differences in the intraoperative blood loss, number of cases receiving parathyroid autotransplantation, incidence of recurrent laryngeal nerve injury, incidence of hypocalcemia on the third postoperative day and incidence of hypoparathyroidism between the two groups (all P>0.05). The recurrence rate in Dunhill operation group was significantly lower than that in bilateral subtotal thyroidectomy group during follow-up period (P=0.027).
Conclusion: Dunhill operation is safe and effective in treatment of multinodular goiter, and also can effectively reduce the postoperative recurrence of the disease. So, it is recommended to be used in clinical practice.
Keywords：
Goiter
Nodular; Thyroidectomy; Postoperative Complications; Recurrence
Methods: The clinical data of 58 patients undergoing Dunhill operation and 60 patients undergoing bilateral subtotal thyroidectomy from January 2011 to January 2017 in the Fourth Affiliated Hospital of Harbin Medical University were retrospectively analyzed. All patients were confirmed to have bilateral multinodular goiter by intraoperative pathological diagnosis.
Results: The preoperative data showed no significant difference between the two groups of patients (all P>0.05). In Dunhill operation group compared with bilateral subtotal thyroidectomy group, the average operative time was significantly prolonged (95.41 min vs. 52.48 min, P=0.000) and the incidence of hypocalcemia on the first postoperative day was significantly increased (12.1% vs. 1.7%, P=0.031), while there were no significant differences in the intraoperative blood loss, number of cases receiving parathyroid autotransplantation, incidence of recurrent laryngeal nerve injury, incidence of hypocalcemia on the third postoperative day and incidence of hypoparathyroidism between the two groups (all P>0.05). The recurrence rate in Dunhill operation group was significantly lower than that in bilateral subtotal thyroidectomy group during follow-up period (P=0.027).
Conclusion: Dunhill operation is safe and effective in treatment of multinodular goiter, and also can effectively reduce the postoperative recurrence of the disease. So, it is recommended to be used in clinical practice.