Klinik für Endokrine Chirurgie, Marienhaus Klinikum Mainz, Germany.
Klinik für Endokrine Chirurgie, Bürgerhospital, Frankfurt, Germany.
Br J Surg. 2023 Nov 9;110(12):1808-1814. doi: 10.1093/bjs/znad255.
Outcomes of paediatric thyroid surgery have only been reported in smaller series or over long intervals. The aim of this multicentre study was to describe the recent outcomes of paediatric thyroid surgery in Germany and Austria.
Patients aged less than or equal to 18 years who underwent thyroid surgery and were prospectively documented in the StuDoQ|Thyroid registry between March 2017 and August 2022 were studied.
In total, 604 patients from 90 institutions were included. The mean age was 15.4 years and 75 per cent of patients were female. The most frequent benign pathologies were nodular goitre (35.6 per cent), follicular adenoma (30.1 per cent), and Graves' disease (28.5 per cent). Among 126 thyroid malignancies, papillary thyroid carcinoma was diagnosed in 77.8 per cent of patients, follicular thyroid carcinoma was diagnosed in 10.3 per cent of patients, and medullary thyroid carcinoma was diagnosed in 8.7 per cent of patients. Lymph node metastases were found in 45.9 per cent of patients with papillary thyroid carcinoma and in 36.4 per cent of patients with medullary thyroid carcinoma. Vascular invasion was found in 62.9 per cent of patients with follicular thyroid carcinoma. The mean tumour diameters were 18, 42, and 13 mm in patients with papillary thyroid carcinoma, follicular thyroid carcinoma, and medullary thyroid carcinoma respectively. Early postoperative recurrent laryngeal nerve injury was seen in 27 of 556 patients (4.9 per cent) (22 of 617 (3.6 per cent) nerves at risk with intermittent intraoperative nerve monitoring and 5 of 237 (2.1 per cent) nerves at risk with continuous intraoperative nerve monitoring). Persistent recurrent laryngeal nerve injury was documented in 4 of 556 patients (0.7 per cent). Early postoperative hypoparathyroidism correlated with Graves' disease, thyroid carcinoma, and lymph node dissection.
Papillary thyroid carcinoma and follicular thyroid carcinoma in children were often advanced at presentation. Persistent or recurrent lymph node metastases were mainly seen in papillary thyroid carcinoma. Overall survival was excellent, but longer follow-up is needed.
儿科甲状腺手术的结果仅在较小的系列或较长的时间间隔内报告过。本多中心研究的目的是描述德国和奥地利最近儿科甲状腺手术的结果。
研究纳入了 2017 年 3 月至 2022 年 8 月期间在 StuDoQ|Thyroid 注册中心前瞻性记录的年龄小于或等于 18 岁并接受甲状腺手术的患者。
共纳入了 90 家机构的 604 名患者。平均年龄为 15.4 岁，75%的患者为女性。最常见的良性病变是结节性甲状腺肿（35.6%）、滤泡性腺瘤（30.1%）和格雷夫斯病（28.5%）。在 126 例甲状腺恶性肿瘤中，诊断为乳头状甲状腺癌的患者占 77.8%，滤泡状甲状腺癌占 10.3%，髓样甲状腺癌占 8.7%。45.9%的乳头状甲状腺癌患者和 36.4%的髓样甲状腺癌患者发现淋巴结转移。血管侵犯见于 62.9%的滤泡状甲状腺癌患者。乳头状甲状腺癌、滤泡状甲状腺癌和髓样甲状腺癌患者的平均肿瘤直径分别为 18、42 和 13mm。556 例患者中有 27 例（4.9%）术后早期出现喉返神经损伤（617 例中有 22 例（3.6%）神经在术中间歇性神经监测时有风险，237 例中有 5 例（2.1%）神经在术中连续神经监测时有风险）。556 例患者中有 4 例（0.7%）持续出现喉返神经损伤。术后早期甲状旁腺功能减退与格雷夫斯病、甲状腺癌和淋巴结清扫术有关。
儿童的甲状腺癌和滤泡状甲状腺癌在就诊时往往较为晚期。持续性或复发性淋巴结转移主要见于乳头状甲状腺癌。总体生存率很好，但需要更长时间的随访。
