A Reasonable Amount of Preserved Thyroid Tissue in Thyroidectomy for Multi-nodular Nodular Goiter

適量保留甲狀腺殘存組織來治療多發性甲狀腺結節

劉瀚聰(Hang-Tsung Liu) ； 謝焜州(Kun-Chou Hsieh) ； 沈陳石銘(Shyr-Ming Sheen-Chen) ； 周逢復(Fong-Fu Chou)

《Formosan Journal of Surgery》 40卷1期 (2007/02) Pp. 9-15

https://doi.org/10.29833/FJS.200702.0002

摘要

Dunhill手術法促使我們想出一個改良式的手術方法，而在執行甲狀腺次全切除時，能較客觀地保留殘存的甲狀腺組織。本文是在比較改良式Dunhill手術法在治療多發性甲狀腺結節是否能比傳統甲狀腺次全切除，有較低復發率且沒有增高併發症比率。
本研究包括269位病人。266位病人是雙側多發性甲狀腺結節，另外3位病人是合併雙側多發性甲狀腺結節及囊腫。其中1男位病人被分配至接受改良式Dunhill手術法的A組，另外134位病人被分配至接受傳統兩側次甲狀腺全切除併兩側殘留3-4克甲狀腺組織的B組。
A組有1位病人，而B組有8位病人發生復發性甲狀腺結節，這個結果有統計學上的意義。兩組都沒有發生術中切斷反回喉神經的病人。A組有5位病人而B組也有5位病人有術後暫時性反喉神經麻痺的現象，發生率幾乎相等。兩組沒有任何一個病人在術後6個月仍需補充鈣片。兩組病人在追蹤期間或是在最後一次門診仍需服用甲狀腺素的人數，在統計學上也是沒有差異。
根據本篇的研究，我們認為若是從降低甲狀腺結節的復發率，及沒有增加術後甲狀腺功能低下和手術併發症的觀點而言，在治療多發性甲狀腺結節時，改良式Dunhill手術法是一個可以考慮的方法。

並列摘要

Objective: The Dunhill procedure gave us an idea to develop a more objective way to preserve thyroid remnant when performing subtotal lobectomy. We want to study whether a modified ”Dunhill procedure” can decrease the recurrence rate and not increase the complication rate when we perform the procedure for treatment of multiple nodular goiter.
Methods: 269 patients took part in this study. 266 patients had bilateral multiple nodular goiter and 3 patients had bilateral multiple nodular goiter combined with a cyst. One hundred and thirty five (135) patients in group A were operated on with a modified ”Dunhill procedure”. One hundred and thirty four (134) patients in group B were operated on by bilateral subtotal thyroidectomy with 3-4gm of thyroid remnant on each side.
Results: Recurrent nodular goiter occurred in 1 case in group A and 8 cases in group B. The difference was statistically significant (p=0.016) between the two groups. No recurrent laryngeal nerve injury occurred in group A or B intraoperatively. Transient cord palsy was found in 5 patients each in groups A and B. The incidence of temporary nerve palsy was identical (almost identical) in both groups. No patient needed calcium supplement 6 months after surgery. The numbers of patients who needed thyroxine during the follow-up period or still took thyroxine at the last follow up between the two groups were not significantly different.
Conclusion: We conclude that our modified ”Dunhill procedure” could be a considerable method in the treatment of multiple nodular goiter from the viewpoint of a decreased recurrence and without increased hypothyroidism or other complications.

並列關鍵字

multiple nodular goiter ； subtotal thyroidectomy ； modified Dunhill procedure ； goiter recurrence ； complication