Ríos Antonio, Rodríguez José Manuel, Canteras Manuel, Riquelme Juan, Illana Julián, Balsalobre María Dolores, Parrilla Pascual
Servicio de Cirugía General y del Aparato Digestivo I, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia.
Cir Esp. 2005 Feb;77(2):79-85. doi: 10.1016/s0009-739x(05)70812-5.
Multinodular goiter (MG) accounts for a large volume of procedures performed in endocrine surgery departments. However, risk factors for postoperative complications have not been systematically investigated. The aim of the present study was to evaluate surgical outcomes in terms of morbidity and mortality through multivariate statistical analysis with a view to determining risk factors in MG surgery.
A total of 672 patients who underwent surgery for MG were retrospectively reviewed. The variables analyzed were age, sex, prior surgery, disease duration, symptomatology, intrathoracic component, the surgeons experience, surgical technique, identification of structures, associated thyroid carcinoma and thyroid specimen weight. The chi-squared test, Students t-test and logistic regression analysis were performed.
Morbidity was 22% (n = 147) and mostly corresponded to hypoparathyroidisms and transitory recurrent lesions. Risk factors for developing these complications were symptomatic disease (p = 0.0131), hyperthyroidism (p = 0.0333), compressive symptoms (p = 0.0158), clinical grade of the goiter (p = 0.0482), surgical technique (p < 0.00001) and thyroid weight (p = 0.0302). Independent risk factors were surgical technique, hyperthyroidism and goiter grade. The definitive complication rate was 2.2% (n = 15), corresponding to six hypoparathyroidisms (0.9%) and 10 recurrent lesions (1.5%). The risk factor for their development was hyperthyroidism (p = 0.0037; RR = 2.8).
The main independent risk factor for complications after MG surgery is hyperthyroidism.
结节性甲状腺肿（MG）是内分泌外科进行的大量手术的治疗对象。然而，术后并发症的危险因素尚未得到系统研究。本研究的目的是通过多变量统计分析评估手术结局的发病率和死亡率，以确定MG手术的危险因素。
对总共672例行MG手术的患者进行回顾性研究。分析的变量包括年龄、性别、既往手术史、病程、症状、胸内成分、外科医生经验、手术技术、结构识别、伴发甲状腺癌以及甲状腺标本重量。进行了卡方检验、学生t检验和逻辑回归分析。
发病率为22%（n = 147），主要为甲状旁腺功能减退和短暂性喉返神经损伤。发生这些并发症的危险因素有症状性疾病（p = 0.0131）、甲状腺功能亢进（p = 0.0333）、压迫症状（p = 0.0158）、甲状腺肿临床分级（p = 0.0482）、手术技术（p < 0.00001）和甲状腺重量（p = 0.0302）。独立危险因素为手术技术甲状腺功能亢进和甲状腺肿分级。最终并发症发生率为2.2%（n = 15），包括6例甲状旁腺功能减退（0.9%）和10例喉返神经损伤（1.5%）。其发生的危险因素为甲状腺功能亢进（p = 0.0037；RR = 2.8）。
MG手术后并发症的主要独立危险因素是甲状腺功能亢进。
