Snook Kylie L, Stalberg Peter L H, Sidhu Stan B, Sywak Mark S, Edhouse Pamela, Delbridge Leigh
Department of Endocrine and Oncology Surgery, University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, 2065, Sydney, NSW, Australia.
World J Surg. 2007 Mar;31(3):593-8; discussion 599-600. doi: 10.1007/s00268-006-0135-0.
Total thyroidectomy is now the preferred option for the management of benign multinodular goiter (BMNG), and it ought not be associated with recurrent disease. The aim of the present study was to examine the efficacy of total thyroidectomy for BMNG and to review reasons for recurrence.
The study group comprised all patients from January 1980 to December 2005 who underwent a definitive procedure to remove all thyroid tissue for BMNG, and who were subsequently identified as having developed a recurrence. Included were patients who underwent primary total thyroidectomy at our unit, or a two or more stage procedure where a definitive secondary total thyroidectomy was performed at our unit.
There were 3,044 total or secondary total thyroidectomies performed for BMNG during the study period. Ten patients were identified as having developed recurrent BMNG requiring reoperation despite previous complete "total" thyroidectomy. There were 11 sites of recurrence in 10 patients. Only one was a true local recurrence in the thyroid bed. Another 9 recurrences related to the embryology of the thyroid gland, 4 in the pyramidal tract and 5 in the thyrothymic tract. There was one recurrence at another site (submandibular) in a patient with presumed metastatic thyroid cancer despite benign histology. There were no complications in any of the 10 patients.
Total thyroidectomy for BMNG is not only a safe procedure but is efficacious in preventing recurrent disease. Failure to remove embryological remnants such as thyrothymic residue or pyramidal remnants during total thyroidectomy is the major cause of recurrence.
全甲状腺切除术目前是治疗良性结节性甲状腺肿(BMNG)的首选方法,且不应与疾病复发相关。本研究的目的是检验全甲状腺切除术治疗BMNG的疗效,并回顾复发原因。
研究组包括1980年1月至2005年12月期间所有因BMNG接受确定性手术切除所有甲状腺组织且随后被确定复发的患者。包括在本单位接受初次全甲状腺切除术的患者,或接受两阶段或更多阶段手术且在本单位进行确定性二次全甲状腺切除术的患者。
在研究期间,共为BMNG患者进行了3044例全甲状腺切除术或二次全甲状腺切除术。10例患者被确定尽管之前已进行了完整的“全”甲状腺切除术,但仍出现复发性BMNG,需要再次手术。10例患者中有11个复发部位。只有1例是甲状腺床的真正局部复发。另外9例复发与甲状腺胚胎学有关,4例在甲状舌管,5例在甲状腺胸腺管。1例组织学为良性但疑似转移性甲状腺癌的患者在另一个部位(下颌下)复发。10例患者均无并发症。
全甲状腺切除术治疗BMNG不仅是一种安全的手术,而且在预防疾病复发方面有效。全甲状腺切除术中未能切除胚胎残留组织,如甲状腺胸腺残留或甲状舌管残留,是复发的主要原因。