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[再次甲状腺手术:个人经验及文献综述]

[Reoperative thyroid surgery: personal experience and review of the literature].

作者信息

Pironi D, Panarese A, Candioli S, Manigrasso A, La Gioia G, Romani A M, Arcieri S, Mele R, Filippini A

机构信息

Università degli Studi di Roma La Sapienza, Policlinico Umberto I, Dipartimento di Scienze Chirurgiche, U.O.C. Chirurgia General ed Endocrina, Rome.

出版信息

G Chir. 2008 Oct;29(10):407-12.

Abstract

The goal of this study was to evaluate the complication rate of reoperative thyroid surgery and to find out the way to minimize the morbidity associated with it. We reviewed our experience in 622 patients, who underwent thyroid operation from January 2000 to September 2007. Among these ones, 76 were the patients who underwent reoperative thyroid surgery. Prior surgery in the 76 reoperations was: nucleo-resection in 9 pts (12.9%), lobectomy in 43 pts (55.5%), lobectomy+isthmectomy in 7 pts (9.3%), subtotal thyroidectomy in 17 pts (22.2%). Histologic examination revealed: benign lesions in 67 pts (88.15%), papillary cancer in 4 pts (5.26%), follicular cancer in 2 pts (2.63%), follicular adenoma in 1 pt (1.32%) and Hashimoto thyroiditis in 2 pts (2.63%). Complications included: section of recurrent laryngeal nerve, that was reconstructed in the same operation, and bilateral palsy of the recurrent laryngeal nerve so that was necessary to make a tracheotomy. One of the patient at the first thyroid surgery had monolateral palsy of the recurrent laryngeal nerve with dyspnoea and dysphonia. Temporary hypoparathyroidism (Ca<8 mg/dl) occurred in 47.3% of the patients, who underwent reoperative thyroid surgery and in 45.2% of the patients, who underwent prior thyroid surgery. Conclusions. This study documents that reoperative thyroid surgery can be performed with little morbidity to the patient if precise operative rules are respected.

摘要

本研究的目的是评估再次甲状腺手术的并发症发生率,并找出将与之相关的发病率降至最低的方法。我们回顾了2000年1月至2007年9月期间622例接受甲状腺手术患者的经验。其中,76例为接受再次甲状腺手术的患者。76例再次手术患者之前的手术情况为:9例(12.9%)行核切除术,43例(55.5%)行叶切除术,7例(9.3%)行叶切除+峡部切除术,17例(22.2%)行甲状腺次全切除术。组织学检查显示:良性病变67例(88.15%),乳头状癌4例(5.26%),滤泡状癌2例(2.63%),滤泡性腺瘤1例(1.32%),桥本甲状腺炎2例(2.63%)。并发症包括:术中重建的喉返神经切断,以及双侧喉返神经麻痹以致需要行气管切开术。1例首次甲状腺手术患者出现单侧喉返神经麻痹伴呼吸困难和声音嘶哑。再次甲状腺手术患者中47.3%以及首次甲状腺手术患者中45.2%发生暂时性甲状旁腺功能减退(血钙<8mg/dl)。结论。本研究证明,如果遵循精确的手术规则,再次甲状腺手术对患者造成的发病率可以很低。

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