Morbidity after Total Thyroidectomy for Benign Thyroid Disease: Comparison of Graves' Disease and Non-Graves' Disease

目前已有很多報告顯示全甲狀腺切除可以用來安全地處理一些良性的甲狀腺疾病。本研究的目的是回顧本科以全甲狀腺切除處理良性的甲狀腺疾病時可能發生的併發症，特別比較Graves'氏病和非Graves'氏病的差異。本研究共收集於1987年l月至2004年12月間因雙側良性的甲狀腺疾病而接受全甲狀腺切除的病人共107位，所有的病人皆由同一術者所手術，其中包括48位為Graves'氏病、59位為非Graves'氏病。術後發生暫時性／永久性副甲狀腺功能低下和暫時性／永久性喉返神經麻痺的機率分別為34.6%/3.7%和6.5%/1.85%。比較永久性副甲狀腺功能低下和暫時性喉返神經麻痺的發生率發現在Graves'氏病的人比非Graves'氏病的人有顯著較高的發生率。但於暫時性副甲狀腺功能低下、永久性喉返神經麻痺及術後血腫的發生率，兩組之間則沒有顯著的差異。全甲狀腺切除可以用來安全地處理一些非Graves'氏病的良性甲狀腺疾病。但對於Graves'氏病的病人仍有較高的永久性副甲狀腺功能低下和暫時性喉返神經麻痺的發生率。因此對於以全甲狀腺切除來治療Graves'氏病仍需相當的小心。

關鍵字

Graves'氏病；低血鈣；喉返神經麻痺；甲狀腺；甲狀腺切除術

並列摘要

The purpose of this study was to review the safety of total thyroidectomies for benign thyroid disease, with special emphasis on the comparison between Graves' disease and non-Graves' disease. In this study, 107 patients who underwent total thyroidectomies for clinically benign thyroid disease performed by the same surgeon between January 1987 and December 2004 were enrolled; 48 had Graves' disease and 59 had non-Graves' disease. The rates of temporary vs. permanent hypoparathyroidism, hematoma requiring surgical intervention, and temporary vs. permanent recurrent laryngeal nerve palsy (RLNP) after total thyroidectomy for benign thyroid disease were 34.6% vs. 3.7%, 6.5%, and 6.5% vs. 1.85%, respectively. The rates of permanent hypoparathyroidism and temporary RLNP in the Graves' disease group were significantly different when compared with the non-Graves' disease group (8.3% vs. 0% and 11.5% vs. 2.5%, respectively). However, comparing the rates of temporary hypoparathyroidism, permanent RLNP, and postoperative hematoma, there was no statistically significant difference. Compared with total lobectomy, the rates of postoperative hematoma increased significantly for total thyroidectomy (6.5% vs. 0.48%). Total thyroidectomy for non-Graves' benign thyroid disease may be performed with minimal morbidity as has been advocated by many authors. For patients with Graves' disease in this study, however, the complication rates of permanent hypoparathyroidism and temporary RLNP were significantly increased. Therefore, we suggest that total thyroidectomy for Graves' disease should be performed by an experienced surgeon.

並列關鍵字

Graves' disease ； hypocalcemia ； recurrent laryngeal nerve palsy ； thyroid ； thyroidectomy

國際替代計量

Morbidity after Total Thyroidectomy for Benign Thyroid Disease: Comparison of Graves' Disease and Non-Graves' Disease

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