Kupferman Michael E, Mandel Susan J, DiDonato Liesje, Wolf Pat, Weber Randal S
Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, U.S.A.
Laryngoscope. 2002 Jul;112(7 Pt 1):1209-12. doi: 10.1097/00005537-200207000-00013.
When a diagnosis of thyroid cancer is returned following unilateral lobectomy, removal of the contralateral lobe is frequently necessary. Morbidity for completion thyroidectomy includes a reported 2% to 5% risk of recurrent laryngeal nerve (RLN) injury and an 8% to 15% incidence of hypoparathyroidism. In this study, to determine morbidity following completion thyroidectomy, we reviewed our results of reoperative surgery among patients with thyroid cancer.
Retrospective chart review.
Between 1997 and 2000, 36 consecutive patients, 32 females and 4 males, with a mean age of 43.6 years (range, 19-59 y), underwent completion thyroidectomy. Preoperative fine-needle aspiration revealed follicular derived neoplasm in 32 patients (88.9%), indeterminate in 3 patients (8.3%), and Hürthle cell neoplasm in 1 patient (2.8%). The interval between the first and second operation was a mean of 43.3 days (range, 2-103 d).
At the primary surgery, 29 patients (80.6%) had a follicular variant of papillary carcinoma, 6 (16.7%) had follicular carcinoma, and 1 (2.8%) had Hürthle cell carcinoma. Of these, 14 had multifocal disease. In the completion lobe, 20 patients (55.6%) had evidence of thyroid carcinoma. There was a 0% incidence of RLN injury, and the mean pre- and post-completion thyroidectomy serum calcium was 8.9 mg/dL and 8.6 mg/dL, respectively. There was one postoperative hematoma, requiring re-exploration. Five patients (13.9%) had a transient postoperative serum calcium (Ca) <8.0 mg/dL, with one being symptomatic. None required vitamin D or prolonged calcium supplementation.
When completion thyroidectomy is necessary for the treatment of thyroid malignancy, the procedure can be performed safely with low morbidity and is effective for diagnosing and removing occult disease in the remaining thyroid.
当单侧甲状腺叶切除术后确诊为甲状腺癌时，通常需要切除对侧叶。甲状腺全切术的并发症包括据报道有2%至5%的喉返神经（RLN）损伤风险以及8%至15%的甲状旁腺功能减退发生率。在本研究中，为了确定甲状腺全切术后的并发症情况，我们回顾了甲状腺癌患者再次手术的结果。
回顾性病历审查。
1997年至2000年期间，36例连续患者，32例女性和4例男性，平均年龄43.6岁（范围19 - 59岁），接受了甲状腺全切术。术前细针穿刺显示32例患者（88.9%）为滤泡源性肿瘤，3例患者（8.3%）结果不确定，1例患者（2.8%）为许特莱细胞肿瘤。首次手术与第二次手术之间的间隔平均为43.3天（范围2 - 103天）。
在初次手术时，29例患者（80.6%）患有乳头状癌滤泡变体，6例（16.7%）患有滤泡癌，1例（2.8%）患有许特莱细胞癌。其中，14例有多灶性病变。在切除的对侧叶中，20例患者（55.6%）有甲状腺癌证据。喉返神经损伤发生率为0%，甲状腺全切术前和术后血清钙平均值分别为8.9mg/dL和8.6mg/dL。有1例术后血肿，需要再次探查。5例患者（13.
