Department of Visceral Surgery and Medicine Inselspital University Hospital Bern University of Bern, Switzerland.
Swiss Med Wkly. 2012 Aug 14;142:w13643. doi: 10.4414/smw.2012.13643. eCollection 2012.
Goitre recurrence is a common problem following subtotal thyroid gland resection for multinodular goitre disease. The aim of the present study was to evaluate morbidity rate in relation to the side of initial and redo-surgery for recurrent disease.
A total of 1699 patients underwent consecutive thyroid gland surgery between 1997 and 2010 at our institution. One hundred and eighteen patients (6.9%) underwent redo-surgery for recurrent disease after subtotal resection. One hundred and nine patients with complete follow-up were included in the present study.
Recurrent disease was found in 79 patients (72.5%) in the ipsilateral lobe and in 30 patients (27.5%) in the contralateral lobe. The incidence of permanent recurrent laryngeal nerve palsy was significantly higher in patients undergoing redo-surgery on the ipsilateral lobe compared to patients undergoing initial operation (3.8% vs. 1.1%; p = 0.03), whereas no difference was found in patients with contralateral redo-surgery compared to patients undergoing initial operation (p = 1.0). Independent risk factors for contralateral recurrent disease were age at primary operation <37 years (OR 4.86; 95% CI 1.58-15.01) and time to recurrence <20 years (OR 6.53; 95% CI 2.23-19.01).
Morbidity rate for recurrent disease after subtotal resection was significantly higher for ipsilateral redo-surgery compared to initial surgery, whereas redo-surgery can be performed safely on the contralateral lobe. Young age at primary operation and short time to recurrence are independent risk factors for contralateral recurrent disease.
甲状腺次全切除术后，结节性甲状腺肿复发是一个常见问题。本研究旨在评估与初次手术和再次手术的侧别相关的发病率。
1997 年至 2010 年期间，我们机构对 1699 例患者连续进行甲状腺手术。118 例（6.9%）患者在甲状腺次全切除术后因复发性疾病行再次手术。本研究共纳入 109 例随访完整的患者。
79 例（72.5%）患者在同侧叶中发现复发性疾病，30 例（27.5%）患者在对侧叶中发现复发性疾病。与初次手术相比，在同侧叶行再次手术的患者中永久性喉返神经麻痹的发生率明显更高（3.8%比 1.1%；p=0.03），而在对侧叶行再次手术的患者与初次手术相比无差异（p=1.0）。对侧复发病例的独立危险因素为初次手术时年龄<37 岁（OR 4.86；95%CI 1.58-15.01）和复发时间<20 年（OR 6.53；95%CI 2.23-19.01）。
与初次手术相比，甲状腺次全切除术后再次手术在同侧时的复发发病率明显更高，而对侧可安全进行再次手术。初次手术时年龄较小和复发时间较短是对侧复发性疾病的独立危险因素。
