양성 갑상샘 결절의 수술적 치료에서 결절절제술의 임상적 의의

Clinical Significance of Nodulectomy in Surgical Treatment of Benign Thyroid Nodules

  • 이동우 (인제대학교 의과대학 부산백병원 외과학교실) ;
  • 김상효 (인제대학교 의과대학 부산백병원 외과학교실)
  • Lee, Dong-Woo (Department of Surgery, College of Medicine, Inje University, Busan Paik Hospital) ;
  • Kim, Sang-Hyo (Department of Surgery, College of Medicine, Inje University, Busan Paik Hospital)
  • 발행 : 2006.11.30

초록

Purpose : It has been generally accepted that lobectomy is a standard surgical procedure in treatment of benign thyroid nodules. However lobectomy may cause postoperative hypothyroidism. Most of surgeons believe that nodulectomy has its limitation in treatment of thyroid nodules due to recurrence of nodules and presence of cancer. The current study attempts to determine whether nodulectomy is justified in aspects of preservation of thyroid function, risk of recurrence and complications. Methods: Data was collected retrospectively on 74 patients undergoing thyroidectomy(single nodulectomy, n=43;bilateral nodulectomies, n=9;lobectomy with nodulectomy, n=22) for benign thyroid nodules from 1999 to 2004. All patients were evaluated for complication, postoperative thyroid function, and recurrence of benign nodule and cancer were followed by regular ultrasonographic examination for 2-6 years. Results : The pathologic results of 74 patients were nodular hyperplasia(55 patients), Hashimoto's thyroiditis(8 patients), follicular adenoma(7 patients) and papillary carcinoma(4 patients). Average operation time was 30 minutes from skin incision to specimen out. In postoperative follow-up of 70 patients, six cases(8.5%) became mild hypothyroid, and ultrasonographically detected micronodule was also six cases(8.5%). There were no other complications. Conclusion : Thyroid nodulectomy appears to have advantages of relatively few complication and simple procedure with no access to laryngeal nerves. Therefore, it may be one of treatment options in selected cases of benign thyroid nodules.

키워드

참고문헌

  1. McCall A, Jarosz H, Lawrence AM: The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters. Surgery. 1986;100:1128-1132
  2. McHenry CR, Slusarczyk SJ: Hypothyroidisim following hemithyroidectomy: incidence, risk factors, and management. Surgery. 2000;128:994-998 https://doi.org/10.1067/msy.2000.110242
  3. Piper HG, Bugis SP, Wilkins GE, Walker BAM, Wiseman S, Baliski CR: Detecting and defining hypothyroidism after hemithyroidectomy. Am J Surg. 2005;189:587-591 https://doi.org/10.1016/j.amjsurg.2005.01.038
  4. Buchanan MA, Lee D: Thyroid auto-antibodies, lymphocytic infiltration and the development of post-operative hypothyroidism following hemithyroidectomy for non-toxic nodular goitre. J R Coll Surg Edinb. 2001;46:86-90
  5. Shaha AR, Shah JP, Loree TR: Low-risk differentiated thyroid cancer: the need for selective treatment. Ann Surg Oncol. 1997;4:328-333 https://doi.org/10.1007/BF02303583
  6. Ambrosi A, Pezzolla A, Barone G, Quaranta G, Errico D, Iacobone M, et al: Clinical study of residual function and recurrences in patients after partial thyroidectomy for non-toxic nodular goiter. Ann Ital Chir. 1994;65:543-546
  7. Dvorak J, Vlcek P, Neumann J, Smutny S, Pilous D: Surgical treatment of benign tumors of the thyroid gland. Rozhl Chir. 1999;78:16-20
  8. Zelmanovitz T, Zelmanovitz F, Genro S, Gus P, de Azevedo MJ, Gross JL: Analysis of the factors associated with recurrence of post-thyroidectomy goiter. Rev Assoc Med Bras. 1995;41:86-90
  9. Marchesi M, Nuccio G, Faloci C, De Cristofaro F: Recurrences after thyroid lobectomy for benign thyroid diseases: analysis of a clinical-instrumental follow up. Ann Ital Chir. 1998;69:581-586
  10. Basili G, Biagini C, Manetti A, Martini F, Biliotti G: Risk of recurrence following partial thyroidectomy for benign lesions. Report of 58 patients 15-25 years after surgery. Minerva Chir. 2003;58:321-329
  11. Gibelin H, Sierra M, Mothes D, Ingrand P, Levillain P, Jones C, et al: Risk factors for recurrent nodular goiter after thyroidectomy for benign disease: case-control study of 244 patients. World J Surg. 2004;28:1079-1082 https://doi.org/10.1007/s00268-004-7607-x
  12. Date J, Feldt-Rasmussen U, Blichert-Toft M, Hegedus L, Graversen HP: Long-term observation of serum thyroglobulin after resection of nontoxic goiter and relation to ultrasonographically demonstrated relapse. World J Surg. 1996;20:351-356 https://doi.org/10.1007/s002689900057
  13. Berglund J, Bondesson L, Christensen SB, Larsson AS, Tibblin S: Indications for thyroxine therapy after surgery for nontoxic benign goitre. Acta Chir Scand. 1990;156:433-438
  14. Lasagna B, Resegotti A, De Paolis P, Balbo G: Extension of thyroidectomy in the treatment of benign nodular thyroid diseases. Minerva Chir. 1993;48:1421-1424
  15. Welker MJ, Orlov D: Thyroid nodules. Am Fam Physician. 2003;67:559-566
  16. Porzio S, Mariani LM, Gardi G, Lombardi V: Surgical treatment of solitary thyroid nodule. Chir Ital. 2002;54:799-805
  17. Greisen O: A nodule in the thyroid gland. Preoperative examinations and treatment-an analysis of 990 cases. Ugeskr Laeger. 2003;165:1031-1034
  18. Bourquiqnat E, Bunault S, Mayaux MJ: Conditions of the remaining thyroid tissue after partial thyroidectomy. Ann Otolaryngol Chir Cervicofac. 1995;112:330-335