Zusammenfassung
Die Struma multinodosa ist eine häufige Erkrankung, deren Therapie eine zentrale Rolle im allgemein- und viszeralchirurgischen Alltag einnimmt. Auswertungen der nationalen DRG-Statistiken belegen, dass die totale Thyreoidektomie zunehmend partielle Resektionsstrategien ersetzt. Dieser Paradigmenwechsel wird wesentlich durch das Verständnis der Struma multinodosa als Erkrankung des gesamten Organs sowie der durch die totale Thyreoidektomie vermiedenen risikoreicheren Zweiteingriffe aufgrund von inzidentellen Schilddrüsenkarzinomen und Strumarezidiven bei gleichwertigen operativen Risiken begründet. Die vorliegende Evidenz stützt sich jedoch bezüglich der operativen Ergebnisse überwiegend auf zentrumspezifische Daten und weist hinsichtlich der postoperativen Auswirkungen der Hormonsubstitution sowohl nach totaler Thyreoidektomie als auch nach nichttotaler Thyreoidektomie große Lücken auf. Der Erhalt von funktionsrelevantem nicht pathologisch verändertem Schilddrüsengewebe behält daher als Therapiealternative seine Bedeutung. Bei Gewährleistung vergleichend niedriger Komplikationsraten und unter Berücksichtigung der Compliance, der Lebenssituation und des Patientenwunsches stellt die totale Thyreoidektomie jedoch den Regeleingriff zur Behandlung der beidseitigen Knotenstruma dar.
Abstract
Multinodular goiter is a frequent disease which plays a central role in the daily routine of general and visceral surgeons. Analyses of the national DRG statistics reveal that total thyroidectomy is increasingly replacing partial thyroid resections. This paradigm shift is substantiated by the comprehension of multinodular goiter as a disease affecting the whole organ as well as the fact that total thyroidectomy avoids high risk secondary interventions for incidental thyroid carcinomas and recurrent disease while offering comparable operative risks. However, the available evidence on operative results originates predominantly from thyroid centers and clinical data regarding long-term effects of thyroid hormone substitution following total as well as sub-total thyroidectomy are lacking. Therefore, the preservation of functionally relevant normal thyroid tissue retains its relevancy as an alternative treatment. If a comparably low operative risk can be guaranteed and considering the patient’s compliance, life situation and wishes, total thyroidectomy represents the optimal therapy for bilateral multinodular goiter.
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Musholt, T. Totale Thyreoidektomie bei Knotenstruma. Chirurg 81, 603–611 (2010). https://doi.org/10.1007/s00104-009-1880-z
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DOI: https://doi.org/10.1007/s00104-009-1880-z