Tabchouri N, Anil Z, Marques F, Michot N, Dumont P, Arnault V, De Calan L
Service de chirurgie digestive et viscérale, hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France.
Service de chirurgie digestive et viscérale, centre hospitalier de Blois, mail Pierre-Charlot, 41016 Blois, France.
J Visc Surg. 2018 Feb;155(1):11-15. doi: 10.1016/j.jviscsurg.2017.05.006. Epub 2017 Jun 8.
Total thyroidectomy for substernal goiter occasionally requires a sternotomy associated with a cervical incision. We sought to analyze the postoperative complications of thyroidectomy for substernal goiters in our center and more precisely the complications related to the sternotomy. All patients who underwent total thyroidectomy for substernal goiter in our center between 2007 and 2016 were reviewed retrospectively. Patients with combined cervical incision and sternotomy (ST group, n=16) were compared to those with cervical incision alone (CT group, n=54), with regard to postoperative complications. Risk factors for the occurrence of postoperative complications were investigated in this population. A total of 24 patients (34.2%) had one or more postoperative complications. The incidence of transient hypoparathyroidism and recurrent laryngeal nerve injury were higher in the ST group (P=0.001 and P=0.052, respectively). The median duration of hospitalization was longer in the ST group (P<0.001). Eighteen patients (25.8%) had a malignant tumor on final pathology. In univariate analysis, the following risk factors for transient postoperative hypoparathyroidism were identified: sternotomy, preoperative symptomatic character and thyroid height (P=0.001, P=0.009 and P=0.013, respectively). In multivariable analysis, only sternotomy was an independent risk factor for postoperative transient hypoparathyroidism (OR=4.48 [1.1; 18], P=0.035). Sternotomy is associated with added morbidity that is not negligible. This surgical approach should be reserved for substernal goiters that descend into the posterior mediastinum, below the level of the aortic arch, when there is suspicion of carcinoma with loco-regional invasion, or when the thyroid tissue is located mainly intrathoracically (conical shaped thyroid, asymptomatic goiter, ectopic thyroid).
胸骨后甲状腺肿的全甲状腺切除术偶尔需要联合胸骨切开术和颈部切口。我们试图分析本中心胸骨后甲状腺肿甲状腺切除术后的并发症，更确切地说是与胸骨切开术相关的并发症。回顾性分析了2007年至2016年期间在本中心接受胸骨后甲状腺肿全甲状腺切除术的所有患者。将联合颈部切口和胸骨切开术的患者（ST组，n = 16）与仅行颈部切口的患者（CT组，n = 54）在术后并发症方面进行比较。研究了该人群术后并发症发生的危险因素。共有24例患者（34.2%）出现了一种或多种术后并发症。ST组的暂时性甲状旁腺功能减退和喉返神经损伤发生率更高（分别为P = 0.001和P = 0.052）。ST组的中位住院时间更长（P < 0.001）。18例患者（25.8%）最终病理检查发现为恶性肿瘤。在单因素分析中，确定了以下术后暂时性甲状旁腺功能减退的危险因素：胸骨切开术、术前症状特点和甲状腺高度（分别为P = 0.001、P = 0.009和P = 0.013）。在多因素分析中，只有胸骨切开术是术后暂时性甲状旁腺功能减退的独立危险因素（OR = 4.48 [1.1; 18]，P = 0.035）。胸骨切开术会带来不可忽视的额外发病率。当怀疑有局部区域侵犯的癌，或甲状腺组织主要位于胸腔内（锥形甲状腺、无症状甲状腺肿、异位甲状腺），且胸骨后甲状腺肿向下延伸至后纵隔、主动脉弓水平以下时，才应采用这种手术方式。
