Pironi D, Pontone S, Vendettuoli M, Podzemny V, Mascagni D, Arcieri S, Panarese A, Felli E, Filippini A
Department of Surgical Sciences, "Sapienza" University of Rome.
Coloproctology Unit, Ars Medica, Rome, Italy.
Clin Ter. 2014;165(4):e285-90. doi: 10.7417/CT.2014.1744.
Thyroidectomy performed by an experienced surgeon is associated with a low incidence of recurrent laryngeal nerve injury and permanent hypoparathyroidism. During reoperative thyroid surgery there is a higher technical risk because detection and preservation of the recurrent laryngeal nerves and parathyroid glands are more difficult than in the primary surgery.
Our retrospective cohort study was to assess short- and long-term complications associated with reoperative thyroid surgery in order to suggest a technical approach to lower the morbidity rate.
From January 2005 to September 2013, 745 patients underwent surgery for thyroid disease. Before surgery all patients underwent clinical examination, laboratory blood tests, hormonal assays, neck ultrasound, chest radiography and indirect laryngoscopy. Patients were followed up at 1, 3, 6 months and then annually after operation with hormonal assays, blood tests and neck ultrasound.
Eighty (10.7%) out of 745 patients (mean-age= 52.5 years; age-range 18-80) underwent reoperative surgery for recurrent thyroid disease. The primary treatments were enucleoresection (11.2%), thyroid lobectomy(56,3%), thyroid lobectomy with isthmectomy(10%) and subtotal thyroidectomy (22,5%). In the reoperative surgery group (Group Re) the transient RLN complications were 1.3% compared to 0.2% in the primary surgery group (Group P) (p= 0.51). The incidence of temporary hypocalcemia was 45% in the reoperative surgery group vs. 42.7% in the primary surgery group (p=0.72).
Reoperative surgery should be reserved to experienced surgeons. However, even in this case, when surgical maneuvers reserved for primary surgery are applied, then this surgery is associated with a low complications rate.
由经验丰富的外科医生实施的甲状腺切除术，喉返神经损伤和永久性甲状旁腺功能减退的发生率较低。再次甲状腺手术时技术风险更高，因为与初次手术相比，喉返神经和甲状旁腺的检测及保留更加困难。
我们的回顾性队列研究旨在评估再次甲状腺手术相关的短期和长期并发症，以提出一种降低发病率的技术方法。
2005年1月至2013年9月，745例患者接受了甲状腺疾病手术。术前所有患者均接受了临床检查、实验室血液检查、激素测定、颈部超声、胸部X线检查和间接喉镜检查。术后1、3、6个月对患者进行随访，之后每年进行激素测定、血液检查和颈部超声检查。
745例患者（平均年龄52.5岁；年龄范围18 - 80岁）中有80例（10.7%）因复发性甲状腺疾病接受了再次手术。初次治疗方式为摘除术（11.2%）、甲状腺叶切除术（56.3%）、甲状腺叶切除加峡部切除术（10%）和甲状腺次全切除术（22.5%）。再次手术组（复手术组）喉返神经短暂性并发症发生率为1.3%，而初次手术组（初手术组）为0.2%（p = 0.51）。再次手术组暂时性低钙血症发生率为45%，初次手术组为42.7%（p = 0.72）。
再次手术应留给经验丰富的外科医生。然而，即便如此，当采用初次手术的手术操作时，该手术的并发症发生率也较低。
