Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Otolaryngol Head Neck Surg. 2011 Nov;145(5):727-31. doi: 10.1177/0194599811416749. Epub 2011 Aug 22.
Outpatient thyroid surgery for thyroid lobectomy has been shown to be safe and feasible. The safety of outpatient completion thyroidectomy in patients who have previously undergone thyroid lobectomy has not been extensively evaluated in the medical literature to date. The authors sought to evaluate postoperative complications associated with completion thyroidectomy in their institution to determine if it would be safe and feasible to perform as an outpatient procedure.
Case series with chart review.
Tertiary care teaching hospital.
Two hundred four consecutive patients, who underwent completion thyroidectomy after previous thyroid lobectomy from January 2000 to June 2010, comprised the study population. Medical records were reviewed for preoperative and postoperative serum calcium levels, preoperative and postoperative fiber-optic laryngoscopic examination of vocal fold mobility, associated comorbidities, length of hospital stay, drain use, seroma or hematoma formation, final thyroid pathology, and postoperative follow-up.
Overall, 9 patients (4.4%) developed postoperative complications, including transient symptomatic hypocalcemia in 4 patients (2.0%), transient laboratory hypocalcemia in 3 patients (1.5%), seroma formation in 1 patient (0.5%), and hematoma development in 1 patient (0.5%). There were no cases with permanent or temporary vocal fold paralysis. No significant difference was found in the overall complication rate before and after 4 hours of observation (P = .50).
Selected patients who undergo completion thyroidectomy after previous thyroid lobectomy can be safely discharged after 4 hours of postoperative observation with appropriate instructions.
甲状腺叶切除术的门诊甲状腺手术已被证明是安全且可行的。在医学文献中，迄今为止尚未广泛评估先前行甲状腺叶切除术的患者行门诊甲状腺全切除术的安全性。作者试图评估其机构中完成甲状腺切除术的术后并发症，以确定是否可以安全且可行地将其作为门诊手术进行。
病例系列和图表回顾。
三级保健教学医院。
2000 年 1 月至 2010 年 6 月，连续 204 例患者在先前的甲状腺叶切除术后接受了甲状腺全切除术，构成了研究人群。回顾了病历，以了解术前和术后血清钙水平、术前和术后光纤喉镜检查声带活动度、相关合并症、住院时间、引流管使用、血清肿或血肿形成、最终甲状腺病理和术后随访情况。
总体而言，9 例（4.4%）发生了术后并发症，包括 4 例（2.0%）患者出现短暂症状性低钙血症、3 例（1.5%）患者出现短暂实验室低钙血症、1 例（0.5%）患者出现血清肿形成、1 例（0.5%）患者出现血肿形成。无永久性或暂时性声带麻痹病例。观察 4 小时前后总体并发症发生率无显著差异（P =.50）。
对于先前行甲状腺叶切除术的患者，选择行甲状腺全切除术的患者可以在术后观察 4 小时后安全出院，并给予适当的指导。
