Tsai Chung-Hsin, Kuo Chi-Yu, Leu Yi-Shing, Lee Jie-Jen, Cheng Shih-Ping
Department of Surgery, MacKay Memorial Hospital, 92, Chung-Shan North Road, Section 2, Taipei, 104215, Taiwan.
Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, Taiwan.
Updates Surg. 2023 Jan;75(1):209-216. doi: 10.1007/s13304-022-01394-3. Epub 2022 Oct 6.
While an increasing number of patients now undergo lobectomy for low-risk differentiated thyroid cancer, a subset of patients require completion thyroidectomy to facilitate radioactive iodine therapy. Completion thyroidectomy is generally as safe as the initial operation, but a previous study showed that a longer hospitalization is required for completion thyroidectomy. In this study, we reviewed 61 consecutive patients who had been treated with an initial lobectomy and subsequent completion thyroidectomy at our institution from 2012 to 2021. We detected a changepoint in 2016 for the proportion of patients who were treated with a thyroid lobectomy (Pettitt's test P = 0.049). The rate of completion thyroidectomy remained stable throughout the study period. There was no difference in operating time, intraoperative blood loss, perioperative drop in calcium levels, and postoperative hospital stay between surgeries. The patients reported higher pain scores on the day of operation (P = 0.007) and the postoperative day 1 (P = 0.022). Occult papillary microcarcinomas were identified in the contralateral thyroid lobe in 13 (21%) patients. Multifocality was the only predictor for residual malignancy in multivariate regression. In conclusion, patients with differentiated thyroid cancer experienced more pain in the immediate postoperative period following completion thyroidectomy. Hospital stays do not change with appropriate opioid-free pain control.
虽然现在越来越多的低风险分化型甲状腺癌患者接受肺叶切除术，但仍有一部分患者需要进行甲状腺全切术以促进放射性碘治疗。甲状腺全切术通常与初次手术一样安全，但先前的一项研究表明，甲状腺全切术需要更长的住院时间。在本研究中，我们回顾了2012年至2021年在我们机构接受初次肺叶切除术并随后进行甲状腺全切术的61例连续患者。我们检测到2016年接受甲状腺叶切除术的患者比例出现了一个变化点（佩蒂特检验P = 0.049）。在整个研究期间，甲状腺全切术的比例保持稳定。手术之间在手术时间、术中失血、围手术期钙水平下降和术后住院时间方面没有差异。患者在手术当天（P = 0.007）和术后第1天（P = 0.022）报告的疼痛评分更高。在13例（21%）患者的对侧甲状腺叶中发现了隐匿性乳头状微小癌。在多因素回归中，多灶性是残留恶性肿瘤的唯一预测因素。总之，分化型甲状腺癌患者在甲状腺全切术后的术后早期经历了更多疼痛。通过适当的无阿片类药物疼痛控制，住院时间没有变化。
