Division of Endocrine Surgery, NYU Langone Health, New York, NY.
Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Ann Surg. 2020 Mar;271(3):399-410. doi: 10.1097/SLA.0000000000003735.
The aim of this study was to develop evidence-based recommendations for safe, effective and appropriate thyroidectomy.
Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the United States.
The medical literature from January 1, 1985 to November 9, 2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content.
These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches Laryngology Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation.
Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
本研究旨在为安全、有效和适当的甲状腺切除术制定循证建议。
几十年来，甲状腺疾病的外科治疗已经有了很大的发展，导致治疗方法存在差异。在美国，每年进行超过 10 万例甲状腺手术。
由 19 名代表多个学科的甲状腺疾病专家组成的小组对 1985 年 1 月 1 日至 2018 年 11 月 9 日的医学文献进行了回顾。作者使用最佳现有证据构建手术管理建议。使用美国医师学院的分级系统确定证据水平，并通过讨论达成管理建议共识。美国内分泌外科学会的成员审查并评论了内容的初步草案。
这些临床指南分析了甲状腺切除术的适应证及其定义、技术、发病率和结果。具体主题包括发病机制和流行病学、初始评估、影像学、细针穿刺活检诊断、分子检测、适应证、手术范围和结果、术前护理、初次甲状腺切除术、围手术期组织诊断、淋巴结清扫术、同期甲状旁腺切除术、甲状腺功能亢进症、甲状腺肿、辅助和方法学、家族性甲状腺癌、术后护理和并发症、癌症管理和再次手术。
制定循证指南是为了帮助临床医生对甲状腺疾病进行最佳的手术治疗。
