Wang Zhonglin, Yu Jian, Rao Shangrui, Lin Zhe, Pan Zhongliang, Shen Xian
Department of General Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China.
Department of General Surgery, Wenzhou Central Hospital, Wenzhou, 325000, Zhejiang, People's Republic of China.
Cancer Manag Res. 2021 May 18;13:4003-4012. doi: 10.2147/CMAR.S293328. eCollection 2021.
Increased surgical technology has led broad acceptance endoscopic thyroidectomy and its application in the treatment of thyroid diseases, including thyroid carcinoma. Although the incidence of complications and mortality of thyroid surgery has been significantly reduced, serious complications still occur from time to time. The purpose of this retrospective study is to identify the factors that influence the complications of endoscopic thyroidectomy.
This study was carried out between January 2012 and December 2019, where a total of 630 patients undergoing endoscopic thyroidectomy via the total areola approach were retrospectively evaluated to identify the key influencing factors of complications.
The study established that the common complications included recurrent laryngeal nerve injury (3.33%), superior laryngeal nerve injury (2.54%), hypocalcemia (8.57%), and the incidence of complications was acceptable. Both univariate and multivariate analysis showed that thyroid carcinoma (P = 0.041), operation time lasting more than 150 minutes (P = 0.034) and operation before 2017 (P = 0.001) were risk factors of recurrent laryngeal nerve injury. We established that operation after 2017 (P < 0.005) was the only protective factor of superior laryngeal nerve injury. Thyroid carcinoma (P=0.04), operation mode (P=0.001), and surgery before 2017 (P<0.001) are risk factors for parathyroid injury. Among the clinical groups, operation before 2017 was an independent risk factor for all complications.
For thyroid specialists, after the early learning curve, with the continuous improvement of endoscopic operation technology, high-definition equipment and more sophisticated operation equipment can be used in clinical practice, which can prevent and reduce the occurrence of complications.
手术技术的进步使得内镜甲状腺切除术得到广泛认可，并应用于包括甲状腺癌在内的甲状腺疾病的治疗。尽管甲状腺手术的并发症发生率和死亡率已显著降低，但严重并发症仍时有发生。本回顾性研究的目的是确定影响内镜甲状腺切除术并发症的因素。
本研究于2012年1月至2019年12月进行，对630例行乳晕入路内镜甲状腺切除术的患者进行回顾性评估，以确定并发症的关键影响因素。
研究发现常见并发症包括喉返神经损伤（3.33%）、喉上神经损伤（2.54%）、低钙血症（8.57%），并发症发生率可以接受。单因素和多因素分析均显示，甲状腺癌（P = 0.041）、手术时间超过150分钟（P = 0.034）和2017年前手术（P = 0.001）是喉返神经损伤的危险因素。我们确定2017年后手术（P < 0.005）是喉上神经损伤的唯一保护因素。甲状腺癌（P=0.04）、手术方式（P=0.001）和2017年前手术（P<0.001）是甲状旁腺损伤的危险因素。在各临床组中，2017年前手术是所有并发症的独立危险因素。
对于甲状腺专科医生来说，度过早期学习曲线后，随着内镜手术技术的不断提高，临床实践中可使用高清设备及更精密的手术器械，从而预防和减少并发症的发生。
