Lo Gerfo P, Gates R, Gazetas P
Department of Surgery, Columbia University, Columbia Presbyterian Medical Center, New York, New York 10032.
Head Neck. 1991 Mar-Apr;13(2):97-101. doi: 10.1002/hed.2880130203.
With the realization that simple thyroid procedures had a very low rate of complication and that patients often seemed well enough to go home from the recovery room, we began performing them in an ambulatory surgery setting. We review here 134 consecutive thyroid procedures performed at Columbia Presbyterian Medical Center between July 1987 and July 1989. Patients undergoing reoperation, neck dissection, sternal splits, or other concomitant procedures were excluded. There were 105 women and 29 men with an average age of 47 years. Fifty percent of the operations were performed for benign disease, although the most common diagnosis was papillary cancer (44%). Twenty-one operations (16%) were performed under local anesthesia. Most patients underwent surgery in our ambulatory surgery unit and 76 were discharged the day of surgery. Of these patients, 21 underwent total thyroidectomy, 13 subtotal thyroidectomy, and 42 simple thyroid lobectomy. Of the 58 patients who were admitted, 53 were discharged on the day following surgery. The average length of stay was 0.49 days. Extensive pre- and postoperative teaching was given regarding the signs and symptoms associated with the complications of thyroid surgery. All patients were felt to be reliable and capable of understanding the procedure and of complying with the postoperative plans. Postoperative complications included 8 patients (6%) with transient hypocalcemia and 1 patient (0.75%) with permanent unilateral recurrent laryngeal nerve paralysis. All complications occurred in patients who underwent total thyroidectomies. No patient had a postoperative complication requiring reoperation or readmission. We conclude that by using specific selection criteria, thyroid lobectomies and subtotal thyroidectomies can be performed safely in an ambulatory surgery setting without increase in morbidity or mortality.
随着人们认识到简单的甲状腺手术并发症发生率很低，而且患者通常恢复得很好，可以从恢复室直接回家，我们开始在门诊手术环境中开展此类手术。我们回顾了1987年7月至1989年7月在哥伦比亚长老会医学中心连续进行的134例甲状腺手术。再次手术、颈部清扫、胸骨劈开或其他同期手术的患者被排除在外。其中有105名女性和29名男性，平均年龄为47岁。50%的手术是针对良性疾病进行的，尽管最常见的诊断是乳头状癌（44%）。21例手术（16%）在局部麻醉下进行。大多数患者在我们的门诊手术单元接受手术，76例患者在手术当天出院。这些患者中，21例行全甲状腺切除术，13例行次全甲状腺切除术，42例行单纯甲状腺叶切除术。58例住院患者中，53例在术后第一天出院。平均住院时间为0.49天。针对甲状腺手术并发症的相关体征和症状，我们进行了广泛的术前和术后宣教。所有患者都被认为可靠，能够理解手术过程并遵守术后计划。术后并发症包括8例（6%）短暂性低钙血症患者和1例（0.75%）永久性单侧喉返神经麻痹患者。所有并发症均发生在接受全甲状腺切除术的患者中。没有患者出现需要再次手术或再次入院的术后并发症。我们得出结论，通过使用特定的选择标准，甲状腺叶切除术和次全甲状腺切除术可以在门诊手术环境中安全进行，而不会增加发病率或死亡率。
