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甲状腺手术翻修

Revision Thyroid Surgery.

作者信息

Rao Karthik Nagaraja, Satpute Satish, Nagarkar Nitin M, Singh Ambesh

机构信息

Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, India.

Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India.

出版信息

Indian J Surg Oncol. 2022 Mar;13(1):199-207. doi: 10.1007/s13193-021-01467-6. Epub 2021 Nov 4.

Abstract

The incidence of recurrence in well-differentiated thyroid malignancies range from 10 to 30%. It is estimated that about 31-46% of patients with differentiated thyroid cancer will have the persistent disease and 1.2-6.8% will have structural recurrences during post-operative monitoring, depending on the initial therapy and prognostic variables. It is challenging to decide on treatment versus active monitoring following repeated or persistent tumour detection. The biological factors of the tumour and the patient guide us in the overall decision-making. Revision thyroid surgery is technically challenging. The morbidity encountered during the revision surgery is related to the anatomy of the region undergoing dissection, the degree of fibrosis and scarring from prior surgery and the operating surgeon's experience. Successful comprehensive management of revision thyroid surgery needs a multi-disciplinary approach. This review article highlights the definition, indications for revision surgery, identification of recurrent disease, management of parathyroid and recurrent laryngeal nerves with neuromonitoring.

摘要

高分化甲状腺恶性肿瘤的复发率在10%至30%之间。据估计,根据初始治疗和预后变量,约31%-46%的分化型甲状腺癌患者会出现持续性疾病,1.2%-6.8%的患者在术后监测期间会出现结构性复发。在反复或持续检测到肿瘤后,决定是进行治疗还是积极监测具有挑战性。肿瘤和患者的生物学因素指导我们进行总体决策。甲状腺翻修手术在技术上具有挑战性。翻修手术中遇到的发病率与进行解剖的区域的解剖结构、先前手术造成的纤维化和瘢痕形成程度以及手术医生的经验有关。成功地对甲状腺翻修手术进行综合管理需要多学科方法。这篇综述文章重点介绍了翻修手术的定义、适应证、复发性疾病的识别、甲状旁腺的管理以及使用神经监测对喉返神经的管理。

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