Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
J Surg Res. 2022 Sep;277:254-260. doi: 10.1016/j.jss.2022.04.018. Epub 2022 Apr 30.
Surgical excision of substernal thyroid goiters (STG) can be challenging while minimizing postoperative morbidity. Postoperative complication rates associated with transcervical and transthoracic approaches (i.e., partial or total sternotomy) for STG compared to multinodular goiters (MNG) limited to the neck (i.e., non-substernal) remains unclear. This study examines postoperative morbidity related to surgical approaches in the removal of STG and MNG.
A retrospective review of prospectively collected data of 988 patients with STG and non-substernal MNG from a single institution between 2010 and 2021 was performed. Patients were stratified by STG and conventional non-substernal MNG limited to the neck excised by transcervical and transthoracic approach. Postoperative complications including neck hematoma requiring return to the operating room, permanent recurrent laryngeal nerve injury and hypocalcemia, and transient or temporary recurrent laryngeal nerve injury and hypocalcemia were identified. Demographics including age, sex, and race, among others, were analyzed.
Of the 988 cases, there were 887 (90%) MNG and 101 (10%) STG. Of the STG cohort, 11 (11%) required a partial sternotomy and 4 (4%) required a total sternotomy. Permanent complication rates for non-substernal MNG and STG patients were 1.5% and 0.9%, respectively. Only transient or temporary hypocalcemia rates were statistically different between the STG and MNG cohorts (9.9% versus 3.8%, P < 0.001).
Regardless of transcervical or transthoracic approach, postoperative complications associated with the surgical removal of STG are low in the hands of experienced, high-volume thyroid surgeons.
在尽量减少术后发病率的同时，胸骨后甲状腺肿（STG）的外科切除具有挑战性。胸骨后甲状腺肿（STG）与局限于颈部的多结节性甲状腺肿（MNG）相比，经颈入路和经胸入路（即部分或全胸骨切开术）术后并发症的发生率（即胸骨后）仍然不清楚。本研究探讨了 STG 和 MNG 切除手术入路相关的术后发病率。
对 2010 年至 2021 年期间，单一机构内 988 例 STG 和非胸骨后 MNG 患者前瞻性收集的数据进行回顾性分析。根据 STG 和局限于颈部的传统非胸骨后 MNG ，将患者分为经颈入路和经胸入路切除的患者。确定术后并发症包括需要返回手术室的颈部血肿、永久性喉返神经损伤和低钙血症以及暂时性或暂时性喉返神经损伤和低钙血症。分析了包括年龄、性别和种族在内的人口统计学特征。
在 988 例病例中，有 887 例（90%）为 MNG，101 例（10%）为 STG。STG 组中，有 11 例（11%）需要部分胸骨切开术，4 例（4%）需要全胸骨切开术。非胸骨后 MNG 和 STG 患者的永久性并发症发生率分别为 1.5%和 0.9%。只有暂时性或暂时性低钙血症的发生率在 STG 和 MNG 组之间存在统计学差异（9.9%比 3.8%，P <0.001）。
在经验丰富、高容量甲状腺外科医生手中，无论采用经颈入路还是经胸入路，STG 手术切除的术后并发症发生率都较低。
