Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Updates Surg. 2021 Aug;73(4):1-10. doi: 10.1007/s13304-021-01027-1. Epub 2021 Mar 29.
Intrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear. This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy.
In a prospectively gathered cohort undergoing thyroid surgery (2010-2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a 'standard' thyroidectomy (N = 1500).
An intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%).
In patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy.
IV.
胸腔内甲状腺肿是一组具有局限性或广泛胸骨后延伸的异质性疾病。前者可通过颈前入路治疗，而后者有时需要颈胸骨切开术。颈胸骨切开术是否会导致更高的发病率尚不清楚。本研究旨在比较经颈前入路和颈胸骨切开术治疗胸腔内甲状腺肿与标准甲状腺切除术的围手术期发病率。
在 2010 年至 2019 年期间前瞻性收集的甲状腺手术队列中，比较了颈前入路（n=80）和颈胸骨切开术（n=15）治疗胸腔内甲状腺肿的围手术期发病率，并与标准甲状腺切除术（n=1500）进行了比较。
所有甲状腺切除术中有 95 例（6%）术前存在胸腔内延伸。80 例（84%）患者行颈前入路手术，15 例（16%）行颈胸骨切开术。颈胸骨切开术组暂时性喉返神经麻痹的风险明显高于颈前入路组（21%）和标准甲状腺切除术组（3%）。颈前入路术后暂时性低钙血症的风险（28%）与标准甲状腺切除术相似（32%），但高于颈胸骨切开术（20%）。胸骨后延伸的两组均无永久性低钙血症或喉返神经麻痹的病例。颈前入路组（6%）的手术再干预需求明显高于颈胸骨切开术组（0%）和标准甲状腺切除术组（3%）。
在接受胸腔内甲状腺肿甲状腺手术的患者中，颈胸骨切开术与更高的暂时性喉返神经麻痹相关，但两种干预措施均不会增加永久性神经损伤、永久性低钙血症或出血再干预的风险。与颈胸骨切开术相比，颈前入路术后的再干预更为常见。
IV 级。
