Zambudio Antonio Ríos, Rodríguez José, Riquelme Juan, Soria Teresa, Canteras Manuel, Parrilla Pascual
Department of General Surgery and Digestive Apparatus I, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
Ann Surg. 2004 Jul;240(1):18-25. doi: 10.1097/01.sla.0000129357.58265.3c.
(1) To show that total thyroidectomy (TT) can be performed in multinodular goiter (MG) by surgeons with experience in endocrine surgery with a definitive complication rate of 1% or less; and (2) to analyze the risk factors for complications in these patients.
There is current controversy over the role of TT in the treatment of MG; although there are potential benefits, high rates of complications are not acceptable in surgery for a benign pathology.
A prospective study was conducted on 301 MGs meeting the following criteria: (1) bilateral MG; (2) no prior cervical surgery; (3) operation by surgeons with experience in endocrine surgery; (4) no associated parathyroid pathology; (5) no initial thoracic approach; and (6) minimum follow-up of 1 year. Age, sex, time of evolution, symptoms, cervical goiter grade, intrathoracic component, thyroid weight, and presence of associated carcinoma were analyzed as risk factors for complications. The chi test and a logistic regression analysis were applied.
Complications were presented by 62 patients (21%), corresponding to 29 hypoparathyroidisms, 26 recurrent laryngeal nerve injuries, 4 lesions of the superior laryngeal nerve, 3 cervical hematomas, and 1 infection of the cervicotomy. The variables associated with the presence of these complications were hyperthyroidism (P = 0.0033), compressive symptoms (P = 0.0455), intrathoracic component (P = 0.0366), goiter grade (P = 0.0195), and weight of excised specimen (P = 0.0302); hyperthyroidism (relative risk [RR] 2.5) and intrathoracic component (RR 1.5) persisted as independent risk factors. Definitive complications appeared in 3 patients (1%), corresponding to 2 hypoparathyroidisms and 1 recurrent laryngeal nerve injury. Two cases corresponded to a toxic goiter, and the third to an intrathoracic goiter with compressive symptoms.
In endocrine surgery units, TT can be performed for MG with a definitive complication rate of around 1%; the main independent risk factors for the development of complications are hyperthyroidism and goiter size.
（1）证明有内分泌外科手术经验的外科医生可对多结节性甲状腺肿（MG）患者实施全甲状腺切除术（TT），且确定性并发症发生率在1%或更低；（2）分析这些患者发生并发症的危险因素。
目前对于TT在MG治疗中的作用存在争议；尽管存在潜在益处，但对于良性病变的手术而言，高并发症发生率是不可接受的。
对301例符合以下标准的MG患者进行了一项前瞻性研究：（1）双侧MG；（2）既往无颈部手术史；（3）由有内分泌外科手术经验的外科医生实施手术；（4）无相关甲状旁腺病变；（5）未采用初始胸腔入路；（6）最短随访1年。分析年龄、性别、病程、症状、颈部甲状腺肿分级、胸腔内成分、甲状腺重量以及是否存在相关癌作为并发症的危险因素。应用卡方检验和逻辑回归分析。
62例患者（21%）出现并发症，包括29例甲状旁腺功能减退、26例喉返神经损伤、4例喉上神经损伤、3例颈部血肿和1例颈部切口感染。与这些并发症发生相关的变量有甲状腺功能亢进（P = 0.0033）、压迫症状（P = 0.0455）、胸腔内成分（P = 0.0366）、甲状腺肿分级（P = 0.0195）和切除标本重量（P = 0.0302）；甲状腺功能亢进（相对危险度[RR] 2.5）和胸腔内成分（RR 1.5）持续作为独立危险因素。3例患者（1%）出现确定性并发症，包括2例甲状旁腺功能减退和1例喉返神经损伤。2例为毒性甲状腺肿，第3例为有压迫症状的胸腔内甲状腺肿。
在内分泌外科科室，可对MG患者实施TT，确定性并发症发生率约为1%；发生并发症的主要独立危险因素是甲状腺功能亢进和甲状腺肿大小。
