Kim Min-Su, Kim Bo-Hae, Han Young Eun, Nam Dong Woo, Hah J Hun
Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Gyeongju Hospital, Gyeongju, Gyeongsangbuk-do, Korea.
Eur Arch Otorhinolaryngol. 2017 Oct;274(10):3789-3794. doi: 10.1007/s00405-017-4707-4. Epub 2017 Aug 16.
Although thyroidectomy under local anesthesia with monitored anesthesia care (LA-MAC) has been reported, reports of neck dissections beyond level VI under LA-MAC in patients with thyroid cancer are rare. We aimed to analyze clinical data and patient satisfaction levels during thyroidectomy and selective neck dissection by comparing LA-MAC and general anesthesia (GA) in adult patients undergoing these surgeries for thyroid cancer. The 60 enrolled patients comprised 50 patients that underwent thyroidectomy and 10 that underwent selective neck dissection; 30 underwent thyroidectomy (n = 25) or selective neck dissection (n = 5) under LA-MAC and 30 (matched patients) underwent thyroidectomy (n = 25) or selective neck dissection (n = 5) under GA. Complaints of postoperative nausea, vomiting, throat discomfort, and voice changes were significantly fewer in the LA-MAC group than in the GA group. Postoperative pain, odynophagia, dyspnea, and patient satisfaction levels were not significantly different between groups. In the thyroidectomy group, postoperative nausea, vomiting, throat discomfort, and voice changes were less common with LA-MAC, whereas postoperative pain, odynophagia, dyspnea, and patient satisfaction levels were similar for both anesthesia methods. The selective neck dissection group showed no differences between the two anesthesia methods. No postoperative complications were reported in all patients. Our results suggest that LA-MAC can be routinely used for select cases of thyroidectomy and is feasible for selective neck dissection beyond level VI with regard to postoperative discomfort, patient satisfaction levels, and safety. However, further investigations are necessary to clarify these findings.
尽管已有关于在监护麻醉下实施局部麻醉进行甲状腺切除术（LA-MAC）的报道，但甲状腺癌患者在LA-MAC下进行超出VI区的颈部清扫术的报道却很少见。我们旨在通过比较LA-MAC和全身麻醉（GA）对接受甲状腺癌手术的成年患者进行甲状腺切除术和选择性颈部清扫术期间的临床数据和患者满意度。纳入的60例患者包括50例行甲状腺切除术的患者和10例行选择性颈部清扫术的患者；30例在LA-MAC下进行甲状腺切除术（n = 25）或选择性颈部清扫术（n = 5），30例（匹配患者）在GA下进行甲状腺切除术（n = 25）或选择性颈部清扫术（n = 5）。LA-MAC组术后恶心、呕吐、咽喉不适和声音改变的主诉明显少于GA组。两组之间术后疼痛、吞咽痛、呼吸困难和患者满意度无显著差异。在甲状腺切除组中，LA-MAC术后恶心、呕吐、咽喉不适和声音改变较少见，而两种麻醉方法的术后疼痛、吞咽痛、呼吸困难和患者满意度相似。选择性颈部清扫组两种麻醉方法之间无差异。所有患者均未报告术后并发症。我们的结果表明，LA-MAC可常规用于某些甲状腺切除病例，对于超出VI区的选择性颈部清扫术，在术后不适、患者满意度和安全性方面是可行的。然而，需要进一步研究以阐明这些发现。
