当前位置： SCI文献检索 > ANNALS OF SURGERY期刊下所有文献 > A randomized trial of hemithyroidectomy versus Dunhill for the surgical management of asymmetrical multinodular goiter.

A randomized trial of hemithyroidectomy versus Dunhill for the surgical management of asymmetrical multinodular goiter.

Abstract：

OBJECTIVE:To assess the immediate and long-term clinical results of 2 different surgical procedures for the treatment of asymmetrical multinodular goiter (AMG). BACKGROUND:Half of the patients presenting with a single benign thyroid nodule have contralateral subclinical disease. There is a controversy whether these patients should be treated with hemithyroidectomy (HMT) or with a more extensive procedure. METHODS:Adult patients with a benign unilateral dominant nodule and contralateral nodule(s) with a diameter of less than 10 mm detected on neck ultrasonography were randomized to HMT or Dunhill (DUN). Rates of complications, remnant growth, incidental carcinoma, and reoperation were assessed. RESULTS:A total of 118 patients (F/M:110/8, mean age 43 years) were included and randomized: 65 to HMT and 53 to DUN. After randomization, 28 patients were excluded leaving 47 HMT and 43 DUN long-term (55 ± 35 months) evaluable patients. Mean nodule size was 38 and 6 mm for the dominant and contralateral nodules, respectively. No differences were found in operative time, accidental parathyroidectomy, parathyroid autotransplantation, or wound complications. Transient hypocalcemia was more common in DUN (30% vs 8%; P < 0.001). No permanent complications were observed. At the last follow-up visit, thyroid-stimulating hormone was similar in both groups. Remnant growth (20 vs 0%; P < 0.001), appearance of new nodules (55 vs 14%; P < 0.001), and overall reoperation rate (9.2 vs 1.8%, P = 0.2) were more common in HMT, mostly because of undiagnosed cancer requiring completion thyroidectomy. Thirty percent of HMTs developed hypothyroidism and required long-term T4 supplementation. CONCLUSIONS:DUN appears superior to HMT for the treatment of AMG in terms of early reoperation for missed carcinomas and disease progression. Both procedures have a similarly uneventful postoperative course.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Sancho JJ,Prieto R,Dueñas JP,Ribera C,Ripollés J,Larrad A,Sitges-Serra A

doi

10.1097/SLA.0b013e318272df62

subject

Has Abstract

pub_date

2012-11-01 00:00:00

pages

846-51; discussion 851-2

issue

eissn

0003-4932

issn

1528-1140

pii

00000658-201211000-00023

journal_volume

256

pub_type

杂志文章,多中心研究,随机对照试验

在线工具

A randomized trial of hemithyroidectomy versus Dunhill for the surgical management of asymmetrical multinodular goiter.