CHU de Limoges - Hôpital Dupuytren, Chirurgie Digestive, Générale et Endocrinienne, Limoges Cedex, 87042, France.
CHU de Nantes, Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Nantes Cedex 1, 44093, France.
Am J Surg. 2019 Apr;217(4):767-771. doi: 10.1016/j.amjsurg.2018.07.029. Epub 2018 Jul 25.
It is well known that total thyroidectomy is feasible on elderly patients but is linked to complications because of their underlying comorbidities. In this study we analyzed the specific risks linked to surgery, hypoparathyroidism and recurrent nerve palsy.
materials-methods:Prospective, multicentre trial conducted at 13 hospital sites. The primary endpoint was the percentage of patients with postoperative hypocalcaemia (albumin-corrected serum calcium level <2 mmol/L at day 2). Secondary endpoints included recurrent nerve palsy rate at day 2, the percentage of patients with hypocalcaemia (serum calcium level <2 mmol/L) and recurrent nerve palsy at month 6, operating durations and postoperative pain. Patients were separated in two groups: <70 years and ≥70 years old.
In total, 1329 patients who underwent total thyroidectomy were included (median age 51.17 years [18.10; 80.90], 80% women, and hyperthyroidism in 20%, 101 ≥ 70 years old). Rates of hypocalcaemia at day 2 and month 6 were 20.02% and 1.98% respectively. Nasofibroscopy showed postoperative abnormal vocal cord motility in 9.92% cases (hypo-motility 5.76% - immobility 4.16%) and 0.95% at month 6 (hypo-motility 0.48%, immobility 0.48%). Patients ≥70 years had a lower (but non-significant) postoperative and definitive hypocalcaemia rate than patients < 70 years: 14.85% vs 20.44% at day 2 (p = 0.1773) and 0% vs 2.15% at month 6 respectively (p = 0.2557). Abnormal vocal cord motility rate was 12.00% in patients ≥70 years vs 9.75% in patients <70 years at day 2 (p = 0.4702), and 2.06% in patients ≥70 years vs 0.86% at month 6 (p = 0.2340).
Total thyroidectomy in patients ≥70 years is feasible and safe. Age does not increase the morbidity. The study is registered with ClinicalTrials.gov number NCT01551914.
众所周知，全甲状腺切除术对老年患者是可行的，但由于其合并症，与并发症有关。在这项研究中，我们分析了与手术、甲状旁腺功能减退和喉返神经麻痹相关的具体风险。
材料-方法：在 13 个医院进行前瞻性、多中心试验。主要终点是术后低钙血症（第 2 天白蛋白校正血清钙水平<2mmol/L）的患者百分比。次要终点包括第 2 天喉返神经麻痹发生率、第 6 个月低钙血症（血清钙水平<2mmol/L）和喉返神经麻痹发生率、手术时间和术后疼痛。患者分为两组：<70 岁和≥70 岁。
共纳入 1329 例接受全甲状腺切除术的患者（中位年龄 51.17 岁[18.10；80.90]，80%为女性，20%为甲状腺功能亢进，101 例≥70 岁）。第 2 天和第 6 个月低钙血症发生率分别为 20.02%和 1.98%。鼻喉镜检查显示术后声带运动异常 9.92%（运动减弱 5.76%，运动障碍 4.16%），第 6 个月为 0.95%（运动减弱 0.48%，运动障碍 0.48%）。70 岁以上患者的术后和最终低钙血症发生率低于<70 岁患者：第 2 天分别为 14.85%和 20.44%（p=0.1773），第 6 个月分别为 0%和 2.15%（p=0.2557）。第 2 天，70 岁以上患者声带运动异常发生率为 12.00%，<70 岁患者为 9.75%（p=0.4702），第 6 个月为 2.06%，<70 岁患者为 0.86%（p=0.2340）。
70 岁以上患者行全甲状腺切除术是可行和安全的。年龄并不会增加发病率。本研究在 ClinicalTrials.gov 注册，编号为 NCT01551914。
