Vaiman Michael, Nagibin Andrey, Hagag Philippe, Buyankin Alexey, Olevson Julian, Shlamkovich Nathan
Department of Otorhinolaryngology Head and Neck Surgery, Assaf HaRofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
World J Surg. 2008 Jul;32(7):1546-51. doi: 10.1007/s00268-008-9541-9.
The purpose of the present work was to compare rates of postsurgical complications following thyroidectomy for multinodular goiter through a retrospective multicenter cohort study.
All cases of thyroidectomy (total-TT; near total-NT; and bilateral subtotal-ST) performed in two hospitals from 1990 to 2005 were studied to determine the incidence of complications after each procedure. Follow-up checked injury of laryngeal nerves, hypoparathyroidism, hypothyroidism, pathology recurrence, and appearance of neoplasm.
There were 6,223 cases: TT, n = 3,834 (61.6%); ST, n = 2,238 (36%); and NT, n = 151 (2.4%) NT). Of this total, 2,758 (44.3%) patients were men and 3,465 (55.7%) were women with a mean age of 48.7. Postoperative mean follow-up was 7 years, 2 months. Permanent recurrent laryngeal nerve (RLN) injury was observed in 1.4% in the TT group, 1.2% in the ST group, and 1.1% in the NT group (p > 0.1). Permanent hypocalcemia was observed in 2% in TT group, 1.9% in the ST group, and 2% in the NT group (p > 0.1). Permanent hypothyroidism occurred in all patients in the TT and NT groups, compared to 91% of the patients in the ST group (p > 0.1). Recurrence of benign disease was noted in 491 patients (20.5% of ST and NT cases combined; p < 0.05), n = 482 (21.5%) after ST and n = 9 (5.9%) after NT. Of the patients with recurrence, 173 needed a completion thyroidectomy. Malignant transformation was observed in 28 cases.
There is no statistically significant difference in complications among TT, NT, and ST groups. Partial thyroidectomies provide no decisive advantage over total thyroidectomies in terms of subsequent requirements of supplemental hormone therapy. The rate of reoperation in cases of recurrent pathology and incidental carcinoma was high.
本研究旨在通过一项回顾性多中心队列研究，比较多结节性甲状腺肿甲状腺切除术后的手术并发症发生率。
对1990年至2005年在两家医院进行的所有甲状腺切除术病例（全甲状腺切除术-TT；近全甲状腺切除术-NT；双侧次全甲状腺切除术-ST）进行研究，以确定每种手术术后并发症的发生率。随访检查喉返神经损伤、甲状旁腺功能减退、甲状腺功能减退、病理复发和肿瘤出现情况。
共有6223例病例：TT组3834例（61.6%）；ST组2238例（36%）；NT组151例（2.4%）。其中，男性2758例（44.3%），女性3465例（55.7%），平均年龄48.7岁。术后平均随访时间为7年2个月。TT组永久性喉返神经（RLN）损伤发生率为1.4%，ST组为1.2%，NT组为1.1%（p>0.1）。TT组永久性低钙血症发生率为2%，ST组为1.9%，NT组为2%（p>0.1）。TT组和NT组所有患者均发生永久性甲状腺功能减退，而ST组为91%（p>0.1）。491例患者出现良性疾病复发（占ST组和NT组合并病例的20.5%；p<0.05），ST组术后复发482例（21.5%），NT组术后复发9例（5.9%）。复发患者中，173例需要再次行甲状腺切除术。观察到28例发生恶变。
TT组、NT组和ST组并发症发生率无统计学显著差异。在后续补充激素治疗需求方面，部分甲状腺切除术相对于全甲状腺切除术无决定性优势。复发病例和意外癌的再次手术率较高。
