Graves씨병의 외과적 치료

Abstract

1989년 7월부터 1992년 12월까지 울산대학교 의과대학 서울중앙병원 외과에서 Graves씨병으로 수술치료를 받고 추적관찰이 가능하였던 35명의 환자를 대상으로 다음과 같은 결과를 얻어 문헌고찰과 함께 보고하는 바이다.

1) 남녀비는 1:2.9로 여자에게 호발하였으며 중간 연령은 26세로 20대 17명(48.6%), 30대 5명(14.3%)으로 20대와 10대에서 가장 호발하였다.

2) 임상증상과 이학적소견상 경부종물이 전환자에서 관찰되었으며 빈맥은 32예(91.4%), 발한은 30예(87.5%), 피로감은 22예(62.9%), 체중감소는 21예(60.0%), 안구돌출은 16예(45.7%), 진전은 14예(40.0%)였다.

3) 갑상선기능검사는 최초의 혈청 T₃의 평균치가 501.2ng/dl, T₄의 평균치가 14.7ng/dl, TSH의 평균치가 3.14uu/ml였고 수술후의 평균검사치는 T₃가 138.9ng/dl, T₄가 7.66ug/dl, THS가 5.53uu/ml로 정상범위로 회복되었다. 면역학적 검사는 thyroglobulin 항체가 48.3%, microsome 항체가 89.7%의 양성률을 보여 가장 높은 적중률을 보였다. 갑상선주사검사상 전 예에서 방사선섭취의 증가를 관찰할 수 있었다.

4) 수술적응증은 항갑상선제제요법에 반응이 좋지 않았던 예가 14예, 내과치료후 거대갑상선종이 11예로 가장 많았고 수술 전처치로는 22예(62.9%)에서 propranolol, Lugol solution, 항갑선상제제를 병합투여했으며, 13예(37.1%)에서는 Lugol solution와 항갑상선제제를 투여하였다.

5) 수술방법은 19예에서 양엽아전절제술, 15예에서 일측엽전절제술 및 반대측 아전절제술, 1예에서 일측엽전절제술 및 협절제술을 시행하였으며 잔여조직은 평균 5.6gm였고 전 예에서 회귀후두신경을 확인 보존하였다.

6) 수술후 합병증은 일시적 저칼슘협증이 6예로 가장 많았고 일시적인 목소리변성이 2예 있었다. 재수술을 요하는 출혈이나 창상감염은 없었으며 사망 역시 발생하지 않았다.

7) 수술후 정상 갑상선기능을 보인 예가 22명(62.9%)으로 가장 많았고, 잠복성 갑상선기능저하는 9명(25.7%), 갑상선기능항진은 3명(8.6%), 갑상선기능저하는 1예(2.9%)에서 발견되었다.

8) 결론적으로 Graves씨병의 수술치료는 수술전 처치의 발달과 안정된 수술수기로 인하여 치료효과가 높은 치료방법이나 수술후 갑상선기능의 가장 중요한 인자로 인정되는 잔여갑상선의 양을 신중히 고려해야 하며 수술후 정기적 추적관찰이 필수적이며 이에 따른 적절한 치료가 필요하다고 사료되는 바이다.

A clinical study on Graves' disease was made to 35 patients who received operation at the department of surgery of Asan medical center from July. 1989 to Dec. 1992.

The results were as follows.

1) Male to female ratio was 1:2.9 and median age at operation was 26 years with highest incidence in the second and first decade.

2) Almost all of patients had neck mass, palpitation and sweating. Other symptoms were fatigue, weight loss, exophthalmus, tremor, nervouness, irregular mentruation, headache, and dyspnea in the order of decreasing frequency.

3) In thyroid function test, initial mean value of T₃and T₄was 501.2ng/dl and 14.7ug/dl, postoperative mean value of T₃and T₄was 138.9ng/dl and 7.66 ug/dl espectively. Radioiodine uptake was increased in all cases.

4) As a preoperative preparation, antithyroid drug, Lugol solution and propranolol were given to 22 patients(62.9%) and antithyroid drug and Lugol solution were given to 13 patients(37.1%).

5) Methods of operation were bilateral subtotal thyroidectomy in 19 patents, unilateral total and contralateral subtotal lobectomy in 15 patients, and lobectomy with isthmectomy in 1 patient. The estimated average weight of remaining thyoid tissue was 5.6 grams.

6) Postoperative complications were symptomatic transient hypocalcemia in 6 cases(17.1%) and transient voice change in 2 cases(5.7%) but there was no permanent hypoparathyroidism, recurrent laryngeal nerve injury or postoperative death.

7) Follow up period was 3 to 36 months(mean 8.5 months) and there were euthyroids in 22 patients(62.9%), latent hypothroids in 9 patients(25.7%), hyperthyroids in 3 patients(8.6%), and hypothyroid in 1 patient(2.9%).

A clinical study on Graves' disease was made to 35 patients who received operation at the department of surgery of Asan medical center from July. 1989 to Dec. 1992.

The results were as follows.

1) Male to female ratio was 1:2.9 and median age at operation was 26 years with highest incidence in the second and first decade.

2) Almost all of patients had neck mass, palpitation and sweating. Other symptoms were fatigue, weight loss, exophthalmus, tremor, nervouness, irregular mentruation, headache, and dyspnea in the order of decreasing frequency.

3) In thyroid function test, initial mean value of T₃and T₄was 501.2ng/dl and 14.7ug/dl, postoperative mean value of T₃and T₄was 138.9ng/dl and 7.66 ug/dl espectively. Radioiodine uptake was increased in all cases.

4) As a preoperative preparation, antithyroid drug, Lugol solution and propranolol were given to 22 patients(62.9%) and antithyroid drug and Lugol solution were given to 13 patients(37.1%).

5) Methods of operation were bilateral subtotal thyroidectomy in 19 patents, unilateral total and contralateral subtotal lobectomy in 15 patients, and lobectomy with isthmectomy in 1 patient. The estimated average weight of remaining thyoid tissue was 5.6 grams.

6) Postoperative complications were symptomatic transient hypocalcemia in 6 cases(17.1%) and transient voice change in 2 cases(5.7%) but there was no permanent hypoparathyroidism, recurrent laryngeal nerve injury or postoperative death.

7) Follow up period was 3 to 36 months(mean 8.5 months) and there were euthyroids in 22 patients(62.9%), latent hypothroids in 9 patients(25.7%), hyperthyroids in 3 patients(8.6%), and hypothyroid in 1 patient(2.9%).