Farrag Tarik Y, Lin Frank R, Cummings Charles W, Sciubba James J, Koch Wayne M, Flint Paul W, Tufano Ralph P
Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Cancer Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0910, USA.
Arch Otolaryngol Head Neck Surg. 2006 Oct;132(10):1047-51. doi: 10.1001/archotol.132.10.1047.
To determine the incidence and presentation of synchronous thyroid lesions in a patient population undergoing open partial laryngectomy (OPL), and to determine whether routine preoperative evaluation of the thyroid gland prior to OPL is useful to identify synchronous thyroid lesions in order to reduce the need for reoperation in this complex patient population.
Retrospective medical chart review.
Academic institution.
Sixty-seven consecutive patients with laryngeal tumors who had undergone OPL from 1996 to 2005.
Charts of 67 consecutive patients with laryngeal tumors who underwent OPL in 1996 to 2005 have been reviewed for synchronous thyroid lesions. For all patients, reports of (1) complete preoperative examination findings, (2) inpatient course, (3) postoperative follow-up, and (4) postoperative final histopathologic findings were reviewed. For patients with synchronous thyroid lesions, reports of (1) thyroid evaluation and imaging and (2) preoperative (fine-needle aspiration), (3) intraoperative (frozen section), and (4) postoperative (final) histopathologic results for the thyroid lesions were reviewed.
Incidence of synchronous thyroid lesions and laryngeal cancer in patients undergoing OPL.
Eight (11.9%) of 67 (95% confidence interval, 5.3%-22.2%) patients with laryngeal tumors who underwent OPL had evidence of synchronous thyroid lesions. All 8 patients had squamous cell carcinoma of the larynx and underwent either supracricoid or supraglottic laryngectomy. In these 8 patients, synchronous thyroid lesions were incidentally detected. Four patients had papillary thyroid carcinoma, 1 had squamous metaplasia, and 3 had follicular thyroid tissue that was negative for malignancy on final pathologic examination. In 2 patients, the thyroid lesions were detected preoperatively (prior to OPL); in another 2 patients, thyroid masses were detected intraoperatively; and in 4 patients, the thyroid disease was identified postoperatively on histopathologic examination of excised cervical lymph nodes. In 2 patients, thyroidectomy was performed as a second operation after the OPL, and 1 of them had transient vocal fold paralysis for 2 months. Thyroid ultrasonography was performed in 4 patients. In 3 patients, the ultrasonography was performed after the OPL final pathologic findings indicated the presence of metastatic thyroid disease in cervical lymph nodes. Ultrasonography revealed intrathyroidal lesions in all 3 patients.
Patients with laryngeal tumors who will be undergoing OPL might have occult synchronous thyroid lesions. Thyroid surgery in patients with previous OPL may have an increased potential for complication owing to postsurgical changes in the central neck region. Routine preoperative evaluation of the thyroid gland, especially with ultrasonography, to screen for occult synchronous thyroid lesions is recommended for all patients with laryngeal tumors who will be undergoing OPL. Eradication of any thyroid cancer detected preoperatively by fine-needle aspiration should be performed at the same time as OPL. Pros and cons of total thyroidectomy for indeterminate thyroid nodules should be discussed with this patient population.
确定接受开放性部分喉切除术（OPL）的患者群体中同步性甲状腺病变的发生率及表现，并确定OPL术前对甲状腺进行常规评估是否有助于识别同步性甲状腺病变，从而减少该复杂患者群体再次手术的需求。
回顾性病历审查。
学术机构。
1996年至2005年连续67例接受OPL的喉肿瘤患者。
对1996年至2005年连续67例接受OPL的喉肿瘤患者的病历进行审查，以查找同步性甲状腺病变。对于所有患者，审查了（1）术前完整检查结果、（2）住院病程、（3）术后随访以及（4）术后最终组织病理学检查结果的报告。对于有同步性甲状腺病变的患者，审查了（1）甲状腺评估和影像学检查以及（2）术前（细针穿刺）、（3）术中（冰冻切片）和（4）术后（最终）甲状腺病变组织病理学结果的报告。
接受OPL患者中同步性甲状腺病变和喉癌的发生率。
67例接受OPL的喉肿瘤患者中有8例（11.9%，95%置信区间为5.3% - 22.2%）有同步性甲状腺病变的证据。所有8例患者均患有喉鳞状细胞癌，并接受了环状软骨上或声门上喉切除术。在这8例患者中，同步性甲状腺病变是偶然发现的。4例患者患有甲状腺乳头状癌，1例有鳞状化生，3例有滤泡性甲状腺组织，最终病理检查显示为恶性阴性。2例患者术前（OPL之前）检测到甲状腺病变；另外2例患者术中检测到甲状腺肿块；4例患者术后经切除的颈部淋巴结组织病理学检查发现甲状腺疾病。2例患者在OPL后进行了第二次甲状腺切除术，其中1例出现了2个月的短暂声带麻痹。4例患者进行了甲状腺超声检查。3例患者在OPL最终病理结果显示颈部淋巴结存在转移性甲状腺疾病后进行了超声检查。超声检查显示所有3例患者均有甲状腺内病变。
即将接受OPL的喉肿瘤患者可能存在隐匿性同步性甲状腺病变。既往接受过OPL的患者进行甲状腺手术，由于中央颈部区域的术后变化，并发症发生的可能性可能会增加。建议对所有即将接受OPL的喉肿瘤患者进行甲状腺的常规术前评估，尤其是超声检查，以筛查隐匿性同步性甲状腺病变。对于术前通过细针穿刺检测到的任何甲状腺癌，应在进行OPL的同时予以根除。应与该患者群体讨论对不确定甲状腺结节进行全甲状腺切除术的利弊。
