Dunhill手术治疗双侧结节性甲状腺肿的临床疗效分析
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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(95.41minvs.52.48min,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。
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.
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.
引文
[1]Yoldas T,Makay O,Icoz G,et al.Should subtotal thyroidectomy be abandoned in multinodular goiter patients from endemic regions requiring surgery?[J].Int Surg,2015,100(1):9-14.doi:10.9738/INTSURG-D-13-00275.1.
[2]Kunz-Zurbuchen U,Buhr HJ,Hotz HG,et al.Influence of change in surgical practice for benign thyroid disease on postsurgical outcome-Single-center experience in 1400 patients[J].Asian J Surg,2018,41(1):39-46.doi:10.1016/j.asjsur.2016.07.015.
[3]Rayes N,Steinmüller T,Schr?der S,et al.Bilateral subtotal thyroidectomy versus hemithyroidectomy plus subtotal resection(Dunhill procedure)for benign goiter:long-term results of a prospective,randomized study[J].World J Surg,2013,37(1):84-90.doi:10.1007/s00268-012-1793-8.
[4]Barczyński M,Konturek A,Hubalewska-Dydejczyk A,et al.Ten-Year Follow-Up of a Randomized Clinical Trial of Total Thyroidectomy Versus Dunhill Operation Versus Bilateral Subtotal Thyroidectomy for Multinodular Non-toxic Goiter[J].World J Surg,2018,42(2):384-392.doi:10.1007/s00268-017-4230-1.
[5]Müller PE,Kabus S,Robens E,et al.Indications,risks,and acceptance of total thyroidectomy for multinodular benign goiter[J].Surg Today,2001,31(11):958-962.doi:10.1007/s005950170002
[6]Efremidou EI,Papageorgiou MS,Liratzopoulos N,et al.The efficacy and safety of total thyroidectomy in the management of benign thyroid disease:a review of 932 cases[J].Can J Surg,2009,52(1):39-44.
[7]王鹏,谭卓.甲状腺微创外科进展[J].中国普通外科杂志,2017,26(5):655-659.doi:10.3978/j.issn.1005-6947.2017.05.019.Wang P,Tan Z.Advances in minimally invasive thyroid surgery[J].Chinese Journal of General Surgery,2017,26(5):655-659.doi:10.3978/j.issn.1005-6947.2017.05.019.
[8]Mauriello C,Marte G,Canfora A,et al.Bilateral benign multinodular goiter:What is the adequate surgical therapy?Areview of literature[J].Int J Surg,2016,28(Suppl 1):S7-12.doi:10.1016/j.ijsu.2015.12.041.
[9]Mobayen M,Baghi I,Farzan R,et al.Comparison of the results of total thyroidectomy and Dunhill operation in surgical treatment of multinodular goiter[J].Indian J Surg,2015,77(Suppl 3):1137-1141.doi:10.1007/s12262-015-1213-z.
[10]Lap CR,Koopsen J.Hemithyroidectomy Versus Dunhill for Surgical Treatment of Asymmetrical Multinodular Goiter[J].Ann Surg,2015,262(1):e24.doi:10.1097/SLA.0000000000000380.
[11]张大闯,杨海彦,王凤军,等.双侧结节性甲状腺肿合并桥本甲状腺炎不同术式的疗效比较[J].中国普通外科杂志,2014,23(5):634-638.doi:10.7659/j.issn.1005-6947.2014.05.014.Zhang DC,Yang HY,Wang FJ,et al.Efficacy comparison among different surgical procedures for bilateral nodular goiter with concomitant Hashimoto's thyroiditis[J].Chinese Journal of General Surgery,2014,23(5):634-638.doi:10.7659/j.issn.1005-6947.2014.05.014.
[12]万学红,卢雪峰.诊断学[M].北京:人民卫生出版社,2013:115-117.Wan XH,Lu XF.Diagnostics[M].Beijing:People's Military Medical Publishe,2013:115-117.
[13]翟博,武林枫,刘颖新,等.甲状腺下动脉被膜下结扎预防甲状旁腺损伤的体会[J].中国现代普通外科进展,2005,8(1):60-60.doi:10.3969/j.issn.1009-9905.2005.01.026.Zhai B,Wu LF,Liu YX,et al.Prevention of parathyroid injury with subcapsular ligation of the inferior thyroid artery[J].Chinese Journal of Current Advances in General Surgery,2005,8(1):60-60.doi:10.3969/j.issn.1009-9905.2005.01.026.
[14]Sanabria A,Kowalski LP,Tartaglia F.Inferior thyroid artery ligation increases hypocalcemia after thyroidectomy:A meta-analysis[J].Laryngoscope,2018,128(2):534-541.doi:10.1002/lary.26681.
[15]李训海,冯新献,殷德涛.精细化被膜解剖法在分化型甲状腺癌手术中的应用价值[J].中国普通外科杂志,2017,26(5):567-572.doi:10.3978/j.issn.1005-6947.2017.05.006.Li XH,Feng XX,Yin DT.Application value of meticulous capsular dissection in thyroidectomy for differentiated thyroid carcinoma[J].Chinese Journal of General Surgery,2017,26(5):567-572.doi:10.3978/j.issn.1005-6947.2017.05.006.
[16]胡廷辉,马永源.甲状腺一叶全切加对侧大部切除术治疗甲状腺功能亢进的临床评价[J].中国普通外科杂志,2004,13(5):346-348.Hu TH,Ma YY.Evaluation of the effect of one side lobectomy plus opposite side partial lobectomy in the treatment of hyperthyroidism[J].Chinese Journal of General Surgery,2004,13(5):346-348.
[17]田文,姚京.甲状腺全切除术在甲状腺癌外科治疗中的价值及合理选择[J].中国实用外科杂志,2014,34(1):52-54.Tian W,Yao J.The value and reasonable choice of total thyroidectomy in the surgical treatment of thyroid cancer[J].Chinese Journal of Practical Surgery,2014,34(1):52-54.
[18]王大卫,王刚,武林枫,等.甲状腺全切除术中甲状旁腺的辨识和保护[J].中国普通外科杂志,2013,22(11):1431-1434.doi:10.7659/j.issn.1005-6947.2013.11.012.Wang DW,Wang G,Wu LF,et al.Identification and protection of parathyroid glands in total thyroidectomy[J].Chinese Journal of General Surgery,2013,22(11):1431-1434.doi:10.7659/j.issn.1005-6947.2013.11.012.
[19]武林枫,刘连新,赵明,等.甲状腺手术中显露喉返神经的意义[J].中华普通外科杂志,2005,20(2):92-94.doi:10.3760/j.issn:1007-631X.2005.02.008.Wu LF,Liu LX,Zhao M,et al.The clinical implication of exposure of recurrent laryngeal nerve in thyroid surgery[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2005,20(2):92-94.doi:10.3760/j.issn:1007-631X.2005.02.008.
[20]余幼林,胡超华,韩运涛,等.甲状腺手术中喉返神经解剖变异特征及显露方法的再认识[J].中国普通外科杂志,2017,26(5):660-665.doi:10.3978/j.issn.1005-6947.2017.05.020.Yu YL,Hu CH,Han YT,et al.Re-recognition of anatomical variation features of recurrent laryngeal nerve and its exposure methods in thyroid surgery[J].Chinese Journal of General Surgery,2017,26(5):660-665.doi:10.3978/j.issn.1005-6947.2017.05.020.
[21]李新营,彭瑶.甲状腺术后甲状旁腺功能低下的恢复和治疗[J].中国普通外科杂志,2016,25(11):1544-1549.doi:10.3978/j.issn.1005-6947.2016.11.004.Li XY,Peng Y.Recovery and management of hypoparathyroidism following thyroid surgery[J].Chinesen Journal of General Surgery,2016,25(11):1544-1549.doi:10.3978/j.issn.1005-6947.2016.11.004.
[22]孙建伟,杨净渝,刘春生,等.不同甲状腺术式对患者术后甲状旁腺功能、血钙变化的影响[J].中国普通外科杂志,2016,25(1):147-151.doi:10.3978/j.issn.1005-6947.2016.01.023.Sun JW,Yang JY,Liu CS,et al.Effect of different thyroid operations on changes of postoperative parathyroid function and blood calcium levels[J].Chinese Journal of General Surgery,2016,25(1):147-151.doi:10.3978/j.issn.1005-6947.2016.01.023.
[23]陈孝平,汪建平.外科学[M].北京:人民卫生出版社,2013:237-250.Chen XP,Wang JP.Surgery[M].Beijing:People's Military Medical Publishe,2013:237-250.
[24]Sajid T,Qamar Naqvi SR,Qamar Naqvi SS,et al.Recurrent Laryngeal Nerve Injury In Total Versus Subtotal Thyroidectomy[J].J Ayub Med Coll Abbottabad,2016,28(3):559-561.
[25]秦坚,徐晓波,周致圆,等.甲状腺手术方式和喉返神经损伤的关系[J].中国普外基础与临床杂志,2014,21(9):1149-1151.Qin J,Xu XB,Zhou ZY,et al.Relationship of Recurrent Laryngeal Nerve Injury with Surgical Approach[J].Chinese Journal of Bases and Clinics In General Surgery,2014,21(9):1149-1151.
[26]李文渊.甲状腺全切术中甲状旁腺辨识及原位保护[J].中国普通外科杂志,2015,24(5):753-756.doi:10.3978/j.issn.1005-6947.2015.05.028.Li WY.Intraoperative identification and in situ protection of parathyroid glands during total thyroidectomy[J].Chinese Journal of General Surgery,2015,24(5):753-756.doi:10.3978/j.issn.1005-6947.2015.05.028.
[27]Ríos Zambudio A,Rodríguez González JM,Galindo Fernández PJ,et al.Clinical recurrence of multinodular goiter after surgery.A multivariate study on the risk factors[J].Rev Clin Esp,2005,205(1):9-13.
[28]Sewefy AM,Tohamy TA,Esmael TM,et al.Intra-capsular total thyroid enucleation versus total thyroidectomy in treatment of benign multinodular goiter A prospective randomized controlled clinical trial[J].Int J Surg,2017,45:29-34.doi:10.1016/j.ijsu.2017.07.074.
[29]Agarwal G,Aggarwal V.Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter?An evidencebased review[J].World J Surg,2008,32(7):1313-1324.doi:10.1007/s00268-008-9579-8.
[30]刘木元,杨熙鸿,郭海鹏,等.甲状腺全切除术的手术并发症分析[J].中国普通外科杂志,2011,20(11):1171-1174.Liu MY,Yang XH,Guo HP,et al.Surgical complications of total thyroidectomy[J].Chinese Journal of General Surgery,2011,20(11):1171-1174.
[31]Li Y,Li Y,Zhou X.Total Thyroidectomy versus Bilateral Subtotal Thyroidectomy for Bilateral Multinodular Nontoxic Goiter:A MetaAnalysis[J].ORL J Otorhinolaryngol Relat Spec,2016,78(3):167-175.doi:10.1159/000444644.
[2]Kunz-Zurbuchen U,Buhr HJ,Hotz HG,et al.Influence of change in surgical practice for benign thyroid disease on postsurgical outcome-Single-center experience in 1400 patients[J].Asian J Surg,2018,41(1):39-46.doi:10.1016/j.asjsur.2016.07.015.
[3]Rayes N,Steinmüller T,Schr?der S,et al.Bilateral subtotal thyroidectomy versus hemithyroidectomy plus subtotal resection(Dunhill procedure)for benign goiter:long-term results of a prospective,randomized study[J].World J Surg,2013,37(1):84-90.doi:10.1007/s00268-012-1793-8.
[4]Barczyński M,Konturek A,Hubalewska-Dydejczyk A,et al.Ten-Year Follow-Up of a Randomized Clinical Trial of Total Thyroidectomy Versus Dunhill Operation Versus Bilateral Subtotal Thyroidectomy for Multinodular Non-toxic Goiter[J].World J Surg,2018,42(2):384-392.doi:10.1007/s00268-017-4230-1.
[5]Müller PE,Kabus S,Robens E,et al.Indications,risks,and acceptance of total thyroidectomy for multinodular benign goiter[J].Surg Today,2001,31(11):958-962.doi:10.1007/s005950170002
[6]Efremidou EI,Papageorgiou MS,Liratzopoulos N,et al.The efficacy and safety of total thyroidectomy in the management of benign thyroid disease:a review of 932 cases[J].Can J Surg,2009,52(1):39-44.
[7]王鹏,谭卓.甲状腺微创外科进展[J].中国普通外科杂志,2017,26(5):655-659.doi:10.3978/j.issn.1005-6947.2017.05.019.Wang P,Tan Z.Advances in minimally invasive thyroid surgery[J].Chinese Journal of General Surgery,2017,26(5):655-659.doi:10.3978/j.issn.1005-6947.2017.05.019.
[8]Mauriello C,Marte G,Canfora A,et al.Bilateral benign multinodular goiter:What is the adequate surgical therapy?Areview of literature[J].Int J Surg,2016,28(Suppl 1):S7-12.doi:10.1016/j.ijsu.2015.12.041.
[9]Mobayen M,Baghi I,Farzan R,et al.Comparison of the results of total thyroidectomy and Dunhill operation in surgical treatment of multinodular goiter[J].Indian J Surg,2015,77(Suppl 3):1137-1141.doi:10.1007/s12262-015-1213-z.
[10]Lap CR,Koopsen J.Hemithyroidectomy Versus Dunhill for Surgical Treatment of Asymmetrical Multinodular Goiter[J].Ann Surg,2015,262(1):e24.doi:10.1097/SLA.0000000000000380.
[11]张大闯,杨海彦,王凤军,等.双侧结节性甲状腺肿合并桥本甲状腺炎不同术式的疗效比较[J].中国普通外科杂志,2014,23(5):634-638.doi:10.7659/j.issn.1005-6947.2014.05.014.Zhang DC,Yang HY,Wang FJ,et al.Efficacy comparison among different surgical procedures for bilateral nodular goiter with concomitant Hashimoto's thyroiditis[J].Chinese Journal of General Surgery,2014,23(5):634-638.doi:10.7659/j.issn.1005-6947.2014.05.014.
[12]万学红,卢雪峰.诊断学[M].北京:人民卫生出版社,2013:115-117.Wan XH,Lu XF.Diagnostics[M].Beijing:People's Military Medical Publishe,2013:115-117.
[13]翟博,武林枫,刘颖新,等.甲状腺下动脉被膜下结扎预防甲状旁腺损伤的体会[J].中国现代普通外科进展,2005,8(1):60-60.doi:10.3969/j.issn.1009-9905.2005.01.026.Zhai B,Wu LF,Liu YX,et al.Prevention of parathyroid injury with subcapsular ligation of the inferior thyroid artery[J].Chinese Journal of Current Advances in General Surgery,2005,8(1):60-60.doi:10.3969/j.issn.1009-9905.2005.01.026.
[14]Sanabria A,Kowalski LP,Tartaglia F.Inferior thyroid artery ligation increases hypocalcemia after thyroidectomy:A meta-analysis[J].Laryngoscope,2018,128(2):534-541.doi:10.1002/lary.26681.
[15]李训海,冯新献,殷德涛.精细化被膜解剖法在分化型甲状腺癌手术中的应用价值[J].中国普通外科杂志,2017,26(5):567-572.doi:10.3978/j.issn.1005-6947.2017.05.006.Li XH,Feng XX,Yin DT.Application value of meticulous capsular dissection in thyroidectomy for differentiated thyroid carcinoma[J].Chinese Journal of General Surgery,2017,26(5):567-572.doi:10.3978/j.issn.1005-6947.2017.05.006.
[16]胡廷辉,马永源.甲状腺一叶全切加对侧大部切除术治疗甲状腺功能亢进的临床评价[J].中国普通外科杂志,2004,13(5):346-348.Hu TH,Ma YY.Evaluation of the effect of one side lobectomy plus opposite side partial lobectomy in the treatment of hyperthyroidism[J].Chinese Journal of General Surgery,2004,13(5):346-348.
[17]田文,姚京.甲状腺全切除术在甲状腺癌外科治疗中的价值及合理选择[J].中国实用外科杂志,2014,34(1):52-54.Tian W,Yao J.The value and reasonable choice of total thyroidectomy in the surgical treatment of thyroid cancer[J].Chinese Journal of Practical Surgery,2014,34(1):52-54.
[18]王大卫,王刚,武林枫,等.甲状腺全切除术中甲状旁腺的辨识和保护[J].中国普通外科杂志,2013,22(11):1431-1434.doi:10.7659/j.issn.1005-6947.2013.11.012.Wang DW,Wang G,Wu LF,et al.Identification and protection of parathyroid glands in total thyroidectomy[J].Chinese Journal of General Surgery,2013,22(11):1431-1434.doi:10.7659/j.issn.1005-6947.2013.11.012.
[19]武林枫,刘连新,赵明,等.甲状腺手术中显露喉返神经的意义[J].中华普通外科杂志,2005,20(2):92-94.doi:10.3760/j.issn:1007-631X.2005.02.008.Wu LF,Liu LX,Zhao M,et al.The clinical implication of exposure of recurrent laryngeal nerve in thyroid surgery[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2005,20(2):92-94.doi:10.3760/j.issn:1007-631X.2005.02.008.
[20]余幼林,胡超华,韩运涛,等.甲状腺手术中喉返神经解剖变异特征及显露方法的再认识[J].中国普通外科杂志,2017,26(5):660-665.doi:10.3978/j.issn.1005-6947.2017.05.020.Yu YL,Hu CH,Han YT,et al.Re-recognition of anatomical variation features of recurrent laryngeal nerve and its exposure methods in thyroid surgery[J].Chinese Journal of General Surgery,2017,26(5):660-665.doi:10.3978/j.issn.1005-6947.2017.05.020.
[21]李新营,彭瑶.甲状腺术后甲状旁腺功能低下的恢复和治疗[J].中国普通外科杂志,2016,25(11):1544-1549.doi:10.3978/j.issn.1005-6947.2016.11.004.Li XY,Peng Y.Recovery and management of hypoparathyroidism following thyroid surgery[J].Chinesen Journal of General Surgery,2016,25(11):1544-1549.doi:10.3978/j.issn.1005-6947.2016.11.004.
[22]孙建伟,杨净渝,刘春生,等.不同甲状腺术式对患者术后甲状旁腺功能、血钙变化的影响[J].中国普通外科杂志,2016,25(1):147-151.doi:10.3978/j.issn.1005-6947.2016.01.023.Sun JW,Yang JY,Liu CS,et al.Effect of different thyroid operations on changes of postoperative parathyroid function and blood calcium levels[J].Chinese Journal of General Surgery,2016,25(1):147-151.doi:10.3978/j.issn.1005-6947.2016.01.023.
[23]陈孝平,汪建平.外科学[M].北京:人民卫生出版社,2013:237-250.Chen XP,Wang JP.Surgery[M].Beijing:People's Military Medical Publishe,2013:237-250.
[24]Sajid T,Qamar Naqvi SR,Qamar Naqvi SS,et al.Recurrent Laryngeal Nerve Injury In Total Versus Subtotal Thyroidectomy[J].J Ayub Med Coll Abbottabad,2016,28(3):559-561.
[25]秦坚,徐晓波,周致圆,等.甲状腺手术方式和喉返神经损伤的关系[J].中国普外基础与临床杂志,2014,21(9):1149-1151.Qin J,Xu XB,Zhou ZY,et al.Relationship of Recurrent Laryngeal Nerve Injury with Surgical Approach[J].Chinese Journal of Bases and Clinics In General Surgery,2014,21(9):1149-1151.
[26]李文渊.甲状腺全切术中甲状旁腺辨识及原位保护[J].中国普通外科杂志,2015,24(5):753-756.doi:10.3978/j.issn.1005-6947.2015.05.028.Li WY.Intraoperative identification and in situ protection of parathyroid glands during total thyroidectomy[J].Chinese Journal of General Surgery,2015,24(5):753-756.doi:10.3978/j.issn.1005-6947.2015.05.028.
[27]Ríos Zambudio A,Rodríguez González JM,Galindo Fernández PJ,et al.Clinical recurrence of multinodular goiter after surgery.A multivariate study on the risk factors[J].Rev Clin Esp,2005,205(1):9-13.
[28]Sewefy AM,Tohamy TA,Esmael TM,et al.Intra-capsular total thyroid enucleation versus total thyroidectomy in treatment of benign multinodular goiter A prospective randomized controlled clinical trial[J].Int J Surg,2017,45:29-34.doi:10.1016/j.ijsu.2017.07.074.
[29]Agarwal G,Aggarwal V.Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter?An evidencebased review[J].World J Surg,2008,32(7):1313-1324.doi:10.1007/s00268-008-9579-8.
[30]刘木元,杨熙鸿,郭海鹏,等.甲状腺全切除术的手术并发症分析[J].中国普通外科杂志,2011,20(11):1171-1174.Liu MY,Yang XH,Guo HP,et al.Surgical complications of total thyroidectomy[J].Chinese Journal of General Surgery,2011,20(11):1171-1174.
[31]Li Y,Li Y,Zhou X.Total Thyroidectomy versus Bilateral Subtotal Thyroidectomy for Bilateral Multinodular Nontoxic Goiter:A MetaAnalysis[J].ORL J Otorhinolaryngol Relat Spec,2016,78(3):167-175.doi:10.1159/000444644.
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