颈部甲状腺肿与胸骨后甲状腺肿手术效果的差异：一项国际多中心评估
Differences in surgical outcomes between cervical goiter and retrosternal goiter: an international, multicentric evaluation.
作者信息
Cappellacci Federico, Canu Gian Luigi, Rossi Leonardo, De Palma Andrea, Mavromati Maria, Kuczma Paulina, Di Filippo Giacomo, Morelli Eleonora, Demarchi Marco Stefano, Brazzarola Paolo, Materazzi Gabriele, Calò Pietro Giorgio, Medas Fabio
机构信息
Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy.
出版信息
Front Surg. 2024 Feb 6;11:1341683. doi: 10.3389/fsurg.2024.1341683. eCollection 2024.
INTRODUCTION
Goiter is a common problem in clinical practice, representing a large part of clinical evaluations for thyroid disease. It tends to grow slowly and progressively over several years, eventually occupying the thoracic inlet with its lower portion, defining the situation known as retrosternal goiter. Total thyroidectomy is a standardized procedure that represents the treatment of choice for all retrosternal goiters, but when is performed for such disease, a higher risk of postoperative morbidity is variously reported in the literature. The aims of our study were to compare the perioperative and postoperative outcomes in patients with cervical goiters and retrosternal goiters undergoing total thyroidectomy.
METHODS
In our retrospective, multicentric evaluation we included 4,467 patients, divided into two groups based on the presence of retrosternal goiter (group A) or the presence of a classical cervical goiter (group B).
RESULTS
We found statistically significant differences in terms of transient hypoparathyroidism (19.9% in group A vs. 9.4% in group B, < 0.001) and permanent hypoparathyroidism (3.3% in group A vs. 1.6% in group B, = 0.035). We found no differences in terms of transient RNLI between group A and group B, while the occurrence of permanent RLNI was higher in group A compared to group B (1.4% in group A vs. 0.4% in group B, = 0.037). Moreover, no differences in terms of unilateral RLNI were found, while bilateral RLNI rate was higher in group A compared to group B (1.1% in group A vs. 0.1% in group B, = 0.015).
DISCUSSION
Wound infection rate was higher in group A compared to group B (1.4% in group A vs. 0.2% in group B, = 0.006). Based on our data, thyroid surgery for retrosternal goiter represents a challenging procedure even for highly experienced surgeons, with an increased rate of some classical thyroid surgery complications. Referral of these patients to a high-volume center is mandatory. Also, intraoperative nerve monitoring (IONM) usage in these patients is advisable.
引言
甲状腺肿是临床实践中的常见问题，占甲状腺疾病临床评估的很大一部分。它往往在数年中缓慢且渐进性生长，最终其下部占据胸廓入口，形成所谓的胸骨后甲状腺肿。全甲状腺切除术是一种标准化手术，是所有胸骨后甲状腺肿的首选治疗方法，但文献报道，针对此类疾病进行该手术时，术后并发症的风险较高。我们研究的目的是比较接受全甲状腺切除术的颈部甲状腺肿患者和胸骨后甲状腺肿患者的围手术期及术后结果。
方法
在我们的回顾性多中心评估中，纳入了4467例患者，根据是否存在胸骨后甲状腺肿分为两组（A组）或是否存在典型的颈部甲状腺肿（B组）。
结果
我们发现，在短暂性甲状旁腺功能减退方面存在统计学显著差异（A组为19.9%，B组为9.4%，<0.001）以及永久性甲状旁腺功能减退方面（A组为3.3%，B组为1.6%，=0.035）。我们发现A组和B组在短暂性喉返神经损伤方面无差异，而A组永久性喉返神经损伤的发生率高于B组（A组为1.4%，B组为0.4%，=0.037）。此外，在单侧喉返神经损伤方面未发现差异，而A组双侧喉返神经损伤率高于B组（A组为1.1%，B组为0.1%，=0.015）。
讨论
A组的伤口感染率高于B组（A组为1.4%，B组为0.2%，=0.006）。根据我们的数据，即使对于经验丰富的外科医生而言，胸骨后甲状腺肿的甲状腺手术也是一项具有挑战性的手术，一些经典甲状腺手术并发症的发生率会增加。必须将这些患者转诊至高容量中心。此外，建议在这些患者中使用术中神经监测（IONM）。
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