Calò P G, Pisano G, Medas F, Tatti A, Tuveri M, Nicolosi A
Department of Surgical Sciences, University of Cagliari, Italy.
G Chir. 2012 Oct;33(10):335-8.
Reoperative thyroid surgery is an uncommon operation associated with a higher complication rate; we reviewed our series of patients on whom reoperative thyroid surgery was performed.
106 patients had a thyroid reoperation for recurrent multinodular goiter (93 patients), recurrent thyrotoxicosis (3) or suspected malignancy (10); bilateral completion thyroidectomy was performed in 68 cases, lobectomy in 36, removal of a mediastinal recurrence and of a pyramidal remnant in 1 patient respectively.
Temporary hypoparathyroidism occurred in 41 patients (38.67%), definitive in 7 (6.6%), transient recurrent laryngeal nerve palsy in 5 (4.71%), permanent nerve palsy in 1 (0.94%); in 3 cases (2.83%) surgical revision of haemostasis was necessary for postoperative haemorrhage. After monolateral surgery we had 13 cases of transient hypoparathyroidism (34.21%), 2 of definitive (5.26%) and 1 transient recurrent laryngeal nerve palsy (2.63%); after bilateral surgery we had 29 cases of transient hypoparathyroidism (42.64%), 5 of definitive (7.35%), 4 of transient recurrent laryngeal nerve palsy (5.88%), 1 of definitive (1.47%) and 3 of postoperative bleeding (4.41%).
Reoperative thyroid surgery is a technical challenge with a high incidence of complications. Scarring, edema and friability of the tissues together with distortion of the landmarks make reoperative surgery hazardous. A higher risk of complications is described when previous surgery has been performed on both sides. Total thyroidectomy should be considered the procedure of choice for benign multinodular goiter eliminating the potential of a reoperation. Whenever necessary, reoperative thyroidectomy may be performed safely with little morbidity in experienced hands.
再次甲状腺手术是一种少见的手术，其并发症发生率较高；我们回顾了接受再次甲状腺手术的一系列患者。
106例患者因复发性结节性甲状腺肿（93例）、复发性甲状腺毒症（3例）或疑似恶性肿瘤（10例）接受甲状腺再次手术；68例行双侧甲状腺全切术，36例行甲状腺叶切除术，1例分别切除纵隔复发灶和甲状旁腺残留。
41例患者（38.67%）出现暂时性甲状旁腺功能减退，7例（6.6%）为永久性减退，5例（4.71%）出现暂时性喉返神经麻痹，1例（0.94%）为永久性神经麻痹；3例（2.83%）因术后出血需进行手术止血。单侧手术后，13例出现暂时性甲状旁腺功能减退（34.21%），2例为永久性减退（5.26%），1例出现暂时性喉返神经麻痹（2.63%）；双侧手术后，29例出现暂时性甲状旁腺功能减退（42.64%），5例为永久性减退（7.35%），4例出现暂时性喉返神经麻痹（5.88%），1例为永久性麻痹（1.47%），3例出现术后出血（4.41%）。
再次甲状腺手术是一项技术挑战，并发症发生率高。组织的瘢痕形成、水肿和脆弱性以及解剖标志的扭曲使再次手术具有危险性。双侧均曾接受手术时，并发症风险更高。对于良性结节性甲状腺肿，应考虑将甲状腺全切术作为首选术式，以消除再次手术的可能性。必要时，在经验丰富的医生手中，再次甲状腺手术可安全进行，且发病率较低。
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