甲状腺良性疾病.pptVIP

Benign Thyroid Diseases History Goiter Fist described in China in 2700 BC Thyroid Function Da Vinci – thyroid is designed to fill empty spaces in the neck Parry – thyroid works as a buffer to protect the brain from surges in blood flow Roman physicians – thyroid enlargement is a sign of puberty Cures “application of toad’s blood to the neck” “stroking of the thyroid gland with a cadaverous hand” Surgical advances 500 AD Abdul Kasan Kelebis Abis performed the first goiter excision in Baghdad. Procedure: unknown 1200’s AD Advancements in goiter procedures included applying hot irons through the skin and slowly withdrawing them at right angles. The remaining mass or pedicled tissue was excised. Patients were tied to the table and held down to prevent unwanted movement. Most died from hemorhage or sepsis. 1646 AD Wilhelm Fabricus performed a thyroidectomy with standard surgical scalpels. The 10 y/o girl died, and he was imprisoned 1808 AD Guillaume Dupuytren performed a total thyroidectomy. The patient died postoperatively of “shock” Surgical advances 1866 “If a surgeon should be so foolhardy as to undertake it [thyroidectomy] … every step of the way will be environed with difficulty, every stroke of his knife will be followed by a torrent of blood, and lucky will it be for him if his victim lives long enough to enable him to finish his horrid butchery.” – Samuel David Gross Surgical advances 1883 Kocher’s performs a retrospective review 5000 career thyroidectomies Mortality rates decreased 40% in 1850 (pre-Kocher Bilroth) 12.6% in 1870’s (Kocher begins practice) 0.2% in 1898 (end of Kocher’s career) Many patients developed cretinism or myxedema His conclusions …. Surgical advances In presentation to the German Surgical Congress … “ …the thyroid gland in fact had a function….” - Theodor Kocher, 1883 Medical Advances 1820 AD Johann Straub and Francois Coindet found that use of seaweed (iodine) reduced goiter size and vascularity 1830 AD Graves a