Chan David S Y, Okosieme Onyebuchi E
Department of Surgery, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK.
Department of Endocrinology, Prince Charles Hospital, Merthyr Tydfil, Wales CF47 9DT, UK.
Surgeon. 2014 Aug;12(4):195-200. doi: 10.1016/j.surge.2013.11.020. Epub 2013 Dec 15.
Our objective was to analyse trends in thyroid surgery in Wales over a recent 12-year period.
Details of patients who underwent thyroid surgery across Wales from 1999 to 2010 were analysed from the Patient Episodes Database for Wales [n = 6570, 83% (5429) female, 86% (5634) benign thyroid disease]. We determined age-adjusted thyroidectomy rates from the European standard population and a Poisson regression model was fitted to assess temporal trends. Joinpoint regression was used to calculate annual percentage change (APC) in thyroidectomy rates.
An increase in thyroidectomy rates was observed for malignant disease [APC 4.5, 95% confidence interval (CI) 1.6-7.5] while surgery rates for benign disease declined over the period (APC -3.2, 95% CI -5.1 to -1.3). The use of total thyroidectomy rose from 17% (599/3501) in 1999-2004 to 30% (912/3069) in 2005-2010 (p < 0.001). Total thyroidectomies were performed in a higher proportion of males than females [26% (291/1141) vs. 22% (1220/5429), p = 0.03] and in a greater percentage of patients with malignant disease than benign [36% (337/936) vs. 21% (1174/5634), p < 0.001). General surgeons undertook 83% of thyroid surgery but with a growing involvement of ENT surgeons. Regional disparities were seen in the type of surgery offered to patients with benign thyroid disease.
The use of total thyroidectomy for benign and malignant thyroid disease has risen in Wales. The increase in surgeries performed for malignancy would support a rising incidence of thyroid cancer in the region. Regional disparities in choice of surgery for benign disease require further exploration.
我们的目的是分析威尔士最近12年期间甲状腺手术的趋势。
从威尔士患者事件数据库中分析了1999年至2010年在威尔士接受甲状腺手术的患者详细信息[n = 6570，83%（5429）为女性，86%（5634）为良性甲状腺疾病]。我们根据欧洲标准人口确定了年龄调整后的甲状腺切除术率，并拟合了泊松回归模型以评估时间趋势。采用连接点回归计算甲状腺切除术率的年度百分比变化（APC）。
观察到恶性疾病的甲状腺切除术率有所上升[APC 4.5，95%置信区间（CI）1.6 - 7.5]，而在此期间良性疾病的手术率下降（APC -3.2，95% CI -5.1至 -1.3）。全甲状腺切除术的使用比例从1999 - 2004年的17%（599/3501）上升至2005 - 2010年的30%（912/3069）（p < 0.001）。男性接受全甲状腺切除术的比例高于女性[26%（291/1141）对22%（1220/5429），p = 0.03]，恶性疾病患者接受全甲状腺切除术的比例高于良性疾病患者[36%（337/936）对21%（1174/5634），p < 0.001]。普通外科医生进行了83%的甲状腺手术，但耳鼻喉科医生的参与度在增加。在为良性甲状腺疾病患者提供的手术类型方面存在地区差异。
威尔士对良性和恶性甲状腺疾病采用全甲状腺切除术的情况有所增加。恶性疾病手术量的增加表明该地区甲状腺癌发病率上升。良性疾病手术选择的地区差异需要进一步探讨。
