Department of Pediatric Otorhinolaryngology-Head and Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, Marseille, France.
Department of Ambulatory Medicine, Université de Paris, Assistance Publique - Hôpitaux de Paris - Louis Mourier, Paris, France.
Eur J Pediatr. 2022 Aug;181(8):3049-3054. doi: 10.1007/s00431-022-04511-x. Epub 2022 Jun 7.
The aim of this study is to investigate the risk factors for recurrence after thyroglossal duct cyst (TGDC) surgery, differentiating between infections with and without a cutaneous fistula. This is a retrospective analysis of all paediatric TGDC in a tertiary care centre with at least 2 years of postoperative follow-up. One hundred and thirty-one patients met the inclusion criteria of the study. A multivariate analysis was performed to analyse the main risk factors for recurrence (presence of a fistula, infection, age). 116/131 patients were managed primarily in our institution; 15 patients had previously been operated on in another centre. The recurrence rate was 4.3% (5/116) when the patient was operated on in our institution at the first operation, and overall, recurrence of TGDC occurred in 20/131 (15.3%) patients. Age was not a risk factor for recurrence (p = 0.596). Two or more episodes of preoperative TGDC infection were a statistically significant risk factor in univariate analysis (p = 0.021) but not in multivariate analysis adjusted for age and the presence of a cutaneous fistula (p = 0.385). In multivariate analysis, cutaneous fistula formation was an independent risk factor for recurrence when adjusted for age and preoperative TGDC infection (Hazard ratio = 5.35; p = 0.011).
A preoperative cutaneous fistula was a critical and independent risk factor for recurrence of operated TGDC, whereas age and TGDC infection were not identified as risk factors for recurrence after surgery. This information should be given to patients and parents before surgery.
• The risk factors for recurrence after thyroglossal duct cyst surgery described in the literature are preoperative infection and young age, but this is not supported by strong evidence. • The role of cutaneous fistula formation is unclear.
• The main risk factor for recurrence of TGDC is the presence of a preoperative cutaneous fistula, with an estimated hazard ratio of 4.95 (p = 0.016) in multivariate analysis. • The presence of two preoperative infections was also associated with a greater risk of recurrence in univariate analysis; age and gender were not associated with an increased risk of recurrence.
本研究旨在探讨甲状腺舌管囊肿（TGDC）术后复发的危险因素，并区分伴有和不伴有皮肤瘘管的感染。这是对一家三级保健中心所有儿科 TGDC 的回顾性分析，这些患者均有至少 2 年的术后随访。131 名患者符合本研究的纳入标准。采用多变量分析来分析复发的主要危险因素（瘘管、感染、年龄）。116/131 名患者在我院初次手术时接受了治疗；15 名患者曾在其他中心接受过手术。当患者在我院初次手术时，复发率为 4.3%（5/116），而总的 TGDC 复发率为 131 名患者中的 20 名（15.3%）。年龄不是复发的危险因素（p=0.596）。术前 TGDC 感染 2 次或以上在单变量分析中是一个具有统计学意义的危险因素（p=0.021），但在校正年龄和皮肤瘘管存在后，在多变量分析中并非如此（p=0.385）。在多变量分析中，在校正年龄和术前 TGDC 感染后，皮肤瘘管形成是复发的独立危险因素（危险比=5.35；p=0.011）。
术前皮肤瘘管是 TGDC 术后复发的关键且独立的危险因素，而年龄和 TGDC 感染不是术后复发的危险因素。这些信息应在手术前告知患者和家长。
•文献中描述的 TGDC 手术后复发的危险因素为术前感染和年龄较小，但这并没有得到强有力的证据支持。•皮肤瘘管形成的作用尚不清楚。
•TGDC 复发的主要危险因素是术前存在皮肤瘘管，多变量分析的估计危险比为 4.95（p=0.016）。•术前存在两次感染也与复发风险增加相关，而年龄和性别与复发风险增加无关。
