甲状腺保留型全喉切除术是否会降低甲状腺功能减退的风险？
Does thyroid-sparing total laryngectomy decrease the risk of hypothyroidism?
机构信息
Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa.
Division of Radiation Oncology, Faculty of Health Sciences, University of Cape Town, South Africa.
出版信息
J Laryngol Otol. 2020 Dec;134(12):1069-1072. doi: 10.1017/S0022215120002479. Epub 2020 Nov 27.
BACKGROUND
Thyroid lobectomy is recommended with total laryngectomy for laryngeal cancer in the National Comprehensive Cancer Network ('NCCN') guidelines. However, it is associated with a 32-89 per cent risk of hypothyroidism, with or without adjuvant radiotherapy.
OBJECTIVE
The study aimed to determine whether preserving the whole thyroid, compared to a single lobe, does indeed significantly lower the incidence of hypothyroidism in the setting of total laryngectomy.
METHOD
A retrospective study was conducted at Groote Schuur Hospital in Cape Town, South Africa.
RESULTS
Eighty-four patients met the inclusion criteria. The overall incidence of hypothyroidism was 45.2 per cent. The incidence of hypothyroidism was significantly reduced in patients who underwent thyroid-sparing total laryngectomy compared to hemithyroidectomy (p = 0.037). Adjuvant radiotherapy was associated with a higher incidence of hypothyroidism (p = 0.001).
CONCLUSION
Thyroid-preserving laryngectomy should be advocated in carefully selected patients with advanced laryngeal carcinoma, as it reduces the incidence of hypothyroidism.
背景
美国国家综合癌症网络（“NCCN”）指南建议甲状腺全切除术联合全喉切除术治疗喉癌。然而，无论是否接受辅助放疗，甲状腺全切除术都有 32-89%的风险导致甲状腺功能减退。
目的
本研究旨在确定在全喉切除术的情况下，与单侧甲状腺叶切除术相比，保留整个甲状腺是否确实显著降低甲状腺功能减退的发生率。
方法
该研究在南非开普敦的格罗特舒尔医院进行，采用回顾性研究方法。
结果
84 名患者符合纳入标准。甲状腺功能减退的总发生率为 45.2%。与甲状腺叶切除术相比，行保留甲状腺的全喉切除术患者的甲状腺功能减退发生率显著降低（p=0.037）。辅助放疗与更高的甲状腺功能减退发生率相关（p=0.001）。
结论
在选择合适的晚期喉癌患者中，提倡行保留甲状腺的喉切除术，因为它可降低甲状腺功能减退的发生率。
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