Levin K E, Clark A H, Duh Q Y, Demeure M, Siperstein A E, Clark O H
Department of Surgery, Mt. Zion Medical Center, University of California, San Francisco 94120.
Surgery. 1992 Jun;111(6):604-9.
Patients with thyroid cancer are sometimes denied repeat thyroid operations for fear of an increased risk of complications.
We therefore reviewed our experience in 114 patients with benign or malignant thyroid tumors who underwent 116 thyroid reoperations with or without other procedures. All patients had undergone at least one prior thyroid operation and 16 patients had undergone from two to four thyroid operations before referral. The initial histologic diagnosis before reoperation was thyroid carcinoma in 79 patients, papillary carcinoma in 47 patients, follicular carcinoma in 17 patients, medullary carcinoma in 9 patients, and Hürthle cell carcinoma in 6 patients. Benign disease was present in 35 patients. In 62 patients with cancer, reoperations were performed because of suspected persistent or recurrent disease; one of these patients underwent two reoperations by us. In 17 patients reoperation was to complete total thyroidectomy, primarily so that radioactive iodine could be used to scan for and treat metastatic disease.
Among the 116 reoperations, 102 were completion total thyroidectomy, 8 were near-total or subtotal thyroidectomy, and 6 were completion lobectomy. Histologic examination at reoperation revealed thyroid carcinoma in 51 cases (64%) among the 79 patients who had undergone 80 operations for previous thyroid cancer. Recurrent or persistent cancer was present in 49 of 63 (78%) reoperations for patients with papillary, medullary, and Hürthle cell cancer but in only 2 of 17 (12%) patients with follicular cancer. Cancer also occurred in 8 cases (22%) of the 36 reoperations in 35 patients who initially had benign lesions. Complications included one permanent and one transient palsy of the recurrent laryngeal nerve; both occurred on the side of a previous partial or subtotal lobectomy. Other complications included temporary hypoparathyroidism in four patients, seromas in two patients, and a keloid in one patient.
This study documents that reoperations can be performed with minimal morbidity. Thus patients should not be denied the chance to undergo removal of a persistent tumor or the remnant normal thyroid tissue because of the fear of complications.
甲状腺癌患者有时因担心并发症风险增加而被拒绝再次进行甲状腺手术。
因此，我们回顾了114例患有良性或恶性甲状腺肿瘤患者的手术经验，这些患者接受了116次甲状腺再次手术，其中部分患者还接受了其他手术。所有患者此前至少接受过一次甲状腺手术，16例患者在转诊前接受过2至4次甲状腺手术。再次手术前的初始组织学诊断为甲状腺癌79例，乳头状癌47例，滤泡癌17例，髓样癌9例，许特耳细胞癌6例。良性疾病患者35例。62例癌症患者因怀疑疾病持续或复发而接受再次手术；其中1例患者由我们实施了两次再次手术。17例患者再次手术是为了完成全甲状腺切除术，主要是为了能够使用放射性碘扫描和治疗转移性疾病。
在116次再次手术中，102例为完成全甲状腺切除术，8例为近全或次全甲状腺切除术，6例为完成叶切除术。在79例曾因甲状腺癌接受过80次手术的患者中，再次手术的组织学检查发现51例（64%）为甲状腺癌。乳头状癌、髓样癌和许特耳细胞癌患者的63次再次手术中有49例（78%）存在复发或持续性癌症，但滤泡癌患者的17次手术中仅2例（12%）存在。最初为良性病变的35例患者的36次再次手术中也有8例（22%）发生癌症。并发症包括1例永久性和1例暂时性喉返神经麻痹；均发生在既往部分或次全叶切除术的一侧。其他并发症包括4例患者出现暂时性甲状旁腺功能减退，2例患者出现血清肿，1例患者出现瘢痕疙瘩。
本研究证明再次手术的发病率可降至最低。因此，不应因担心并发症而剥夺患者切除持续性肿瘤或残余正常甲状腺组织的机会。
