Raval Mehul V, Browne Marybeth, Chin Anthony C, Zimmerman Donald, Angelos Peter, Reynolds Marleta
Division of Pediatric Surgery, Children's Memorial Hospital, Northwestern University School of Medicine, Chicago, IL 60614, USA.
J Pediatr Surg. 2009 Aug;44(8):1529-33. doi: 10.1016/j.jpedsurg.2008.11.032.
Total thyroidectomy (TT) is a safe and efficacious treatment of malignant thyroid disease in children. The role of TT in benign thyroid disease is less well-defined. The goal of this study was to compare the safety of TT performed for benign and malignant disease.
The medical records of 31 patients undergoing TT from January 2000 to June 2007 at a single center were reviewed. The benign cohort totaled 15 patients consisting of 12 with Graves' disease, 2 with hyperthyroidism, and 1 with large and symptomatic multinodular goiter. The malignant cohort totaled 16 patients consisting of 9 with malignant disease, 4 with a nodule and history of cancer or radiation exposure, and 3 with RET proto-oncogene mutations.
The most common complication was transient hypocalcemia observed in 7 (46%) of 15 patients with benign disease and 9 (56%) of 16 patients with malignancy (P = .72). Permanent hypocalcemia, defined as need for calcium supplement 6 months postprocedure, was observed in 1 patient with benign disease (6.67%) and 1 patient with malignancy (6.25%; P = 1.0). A single parathyroid gland was reimplanted in 2 patients with malignancy and 2 patients with benign disease (P = 1.0). One case of keloid scar was noted, and no cases of recurrent laryngeal nerve palsy, nerve paralysis, tracheal injury, tracheostomy, or wound infection were encountered in either cohort. There were no cases of relapse hyperthyroidism in the benign cohort.
Similar rates of postoperative complications can be expected with TT for benign thyroid disease as compared to TT for malignant disease. Total thyroidectomy is a safe treatment option for benign thyroid disease in children.
全甲状腺切除术（TT）是治疗儿童恶性甲状腺疾病的一种安全有效的方法。TT在良性甲状腺疾病中的作用尚不太明确。本研究的目的是比较TT治疗良性和恶性疾病的安全性。
回顾了2000年1月至2007年6月在单一中心接受TT的31例患者的病历。良性组共有15例患者，其中12例患有格雷夫斯病，2例患有甲状腺功能亢进症，1例患有巨大且有症状的多结节性甲状腺肿。恶性组共有16例患者，其中9例患有恶性疾病，4例有结节且有癌症或辐射暴露史，3例有RET原癌基因突变。
最常见的并发症是短暂性低钙血症，15例良性疾病患者中有7例（46%）出现，16例恶性疾病患者中有9例（56%）出现（P = 0.72）。永久性低钙血症定义为术后6个月需要补充钙剂，1例良性疾病患者（6.67%）和1例恶性疾病患者（6.25%）出现（P = 1.0）。2例恶性疾病患者和2例良性疾病患者进行了单个甲状旁腺再植（P = 1.0）。记录到1例瘢痕疙瘩，两组均未出现喉返神经麻痹、神经麻痹、气管损伤、气管切开或伤口感染病例。良性组无甲亢复发病例。
与TT治疗恶性疾病相比，TT治疗良性甲状腺疾病的术后并发症发生率相似。全甲状腺切除术是儿童良性甲状腺疾病的一种安全治疗选择。
