Waseem Talat, Ahmed Safia Zahir, Zahara Fatima Tuz, Ashraf Muhammad Hasham, Azim Khwaja Muhammad
Department of Surgery, Shalamar Medical and Dental College, Lahore, Pakistan.
Int Arch Otorhinolaryngol. 2021 Aug 23;26(2):e219-e225. doi: 10.1055/s-0041-1731812. eCollection 2022 Apr.
Total thyroidectomy remains highly technical, with a significant risk of recurrent laryngeal nerve (RLN) compromise and hypoparathyroidism. After identifying RLN, at the level of the ligament of Berry, local factors may compel the surgeon to either dissect along the nerve or the thyroid capsule. The objective of the present study is to compare these two approaches in terms of outcomes and complication rates. This is a retrospective analysis from September, 2013 to April 2019 of 511 consecutive patients undergoing thyroidectomy. General demographics and disease parameters were recorded. At the discretion of the surgeon and according to the demands of the local operative factors, the patients either had dissection along the RLN or along the thyroid capsule. Perioperative and postoperative parameters such as blood loss, duration of surgery, hospital stay, pain scores, analgesia requirements and complications were recorded. The groups were compared with the Pearson chi-squared test or with the Fisher exact test. A p-value < 0.05 was considered statistically significant. The incidence of transient hypocalcaemia and transient RLN compromise were higher when dissection was performed along the nerve as opposed to the plane along the thyroid capsule. Other parameters including operative time, hospital stay, pain scores, analgesia requirement, wound infection, seroma, hemorrhage, and recurrence did not differ between the groups. Subgroup analysis of the patients who presented with complications showed that local factors, malignancy, and extent of surgery correlated positively with complications when dissected along the RLN. Dissection along the capsule of the thyroid during thyroidectomy is a safer plane in terms of low rate of transient RLN injury and hypoparathyroidism as opposed to dissection along the nerve.
全甲状腺切除术技术要求仍然很高，存在喉返神经（RLN）损伤和甲状旁腺功能减退的重大风险。在Berry韧带水平识别喉返神经后，局部因素可能迫使外科医生要么沿神经进行解剖，要么沿甲状腺包膜进行解剖。本研究的目的是比较这两种方法的疗效和并发症发生率。这是一项对2013年9月至2019年4月期间连续511例行甲状腺切除术患者的回顾性分析。记录了一般人口统计学和疾病参数。根据外科医生的判断并根据局部手术因素的要求，患者要么沿喉返神经进行解剖，要么沿甲状腺包膜进行解剖。记录围手术期和术后参数，如失血量、手术时间、住院时间、疼痛评分、镇痛需求和并发症。采用Pearson卡方检验或Fisher精确检验对两组进行比较。p值<0.05被认为具有统计学意义。与沿甲状腺包膜平面进行解剖相比，沿神经进行解剖时，短暂性低钙血症和短暂性喉返神经损伤的发生率更高。其他参数，包括手术时间、住院时间、疼痛评分、镇痛需求、伤口感染、血清肿、出血和复发，两组之间没有差异。对出现并发症的患者进行亚组分析显示，沿喉返神经进行解剖时，局部因素、恶性肿瘤和手术范围与并发症呈正相关。与沿神经进行解剖相比，甲状腺切除术时沿甲状腺包膜进行解剖在短暂性喉返神经损伤和甲状旁腺功能减退发生率较低方面是一个更安全的平面。
