Academic General Surgery Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, 11, Piazza Giulio Cesare, 70124, Bari, Italy.
Updates Surg. 2022 Dec;74(6):1943-1951. doi: 10.1007/s13304-022-01371-w. Epub 2022 Sep 5.
Hyperthyroidism, goiter and thyroiditis have been associated with complex thyroidectomy. Difficult thyroidectomies may implicate longer operating times and higher complication rates, while literature on quantification and prediction of difficulty in thyroidectomy is scant. We aim at assessing the impact of preoperative and intraoperative factors on the technical difficulty of total thyroidectomy (TT) and on the incidence of postoperative complications. We conducted a retrospective study on 197 TT from 343 thyroidectomies performed with intraoperative neuromonitoring between October 2019 and June 2022 (excluding lobectomies, nodal dissection, extra-thyroidal procedures). Operating time (surrogate of TT difficulty), postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and intraoperative characteristics. Vocal fold palsy(VFP) was defined as recovering < 12 months postoperatively. There were 87 thyroid cancers and 110 multinodular goiters (21 hyperfunctioning, 51 mediastinal). Median operating time was 136 min (range 51-310). Within 17.4 months overall median follow-up we recorded two transient VFPs and 12% symptomatic transient hypocalcaemia. At univariable analysis male sex (p = 0.005), BMI (p < 0.001), thyroiditis (p < 0.05), hypervascular goiter (p = 0.003) and thyroid adhesions to surrounding anatomical structures (p < 0.001) were associated with longer operating time. At multivariable analysis male male sex (p = 0.01), obesity (p = 0.001) and thyroid adhesions (p = 0.008) were factors for prolonged operating time. Above-normal anti-thyroid peroxidase antibodies correlated to transient symptomatic hypocalcemia (p < 0.001). Risk factors for complex TT were identified and did not correlate with morbidity rates. Results from this study may help optimizing operating room schedule and inform case selection criteria for training programs in thyroid surgery. Further research is required to confirm these findings.
甲状腺功能亢进、甲状腺肿和甲状腺炎与复杂的甲状腺切除术有关。困难的甲状腺切除术可能涉及更长的手术时间和更高的并发症发生率，而关于甲状腺切除术难度的量化和预测的文献却很少。我们旨在评估术前和术中因素对全甲状腺切除术（TT）技术难度的影响，以及术后并发症的发生率。我们对 2019 年 10 月至 2022 年 6 月期间（不包括 lobectomies、nodal dissection、extra-thyroidal procedures）使用术中神经监测进行的 343 例甲状腺切除术（包括 lobectomies、nodal dissection、extra-thyroidal procedures）中的 197 例 TT 进行了回顾性研究。评估了手术时间（TT 难度的替代指标）、术后低钙血症、喉返神经麻痹和术后出血与术前和术中特征的关系。声带麻痹（VFP）定义为术后恢复<12 个月。有 87 例甲状腺癌和 110 例多结节性甲状腺肿（21 例功能亢进，51 例纵隔）。中位手术时间为 136 分钟（范围 51-310 分钟）。在 17.4 个月的中位随访期内，我们记录了 2 例短暂性 VFP 和 12%的症状性短暂性低钙血症。在单变量分析中，男性（p=0.005）、BMI（p<0.001）、甲状腺炎（p<0.05）、富血管性甲状腺肿（p=0.003）和甲状腺与周围解剖结构的粘连（p<0.001）与手术时间延长有关。在多变量分析中，男性（p=0.01）、肥胖（p=0.001）和甲状腺粘连（p=0.008）是手术时间延长的因素。抗甲状腺过氧化物酶抗体高于正常水平与暂时性症状性低钙血症相关（p<0.001）。复杂 TT 的危险因素已经确定，但与发病率无关。本研究的结果可能有助于优化手术室安排，并为甲状腺手术培训计划提供病例选择标准。需要进一步的研究来证实这些发现。
