de Roy van Zuidewijn D B, Songun I, Kievit J, van de Velde C J
Department of Surgery, University Hospital, Leiden, The Netherlands.
Ann Surg Oncol. 1995 Jan;2(1):56-60. doi: 10.1007/BF02303703.
The morbidity of thyroid surgery is low. Despite this, some authors advocate a subtotal thyroidectomy instead of a total thyroidectomy, to avoid the higher morbidity associated with a total thyroidectomy.
We retrospectively evaluated the complications of thyroid surgery in Leiden between January 1, 1982 and October 1, 1990. Three hundred forty-one patients--261 women and 80 men--had 356 operations; 15 patients were operated on twice; there were 152 total hemithyroidectomies, 3 subtotal hemithyroidectomies, 33 total thyroidectomies, 122 bilateral subtotal hemithyroidectomies, 12 combinations of total and subtotal hemithyroidectomies, and 34 other operations.
Calculated for the nerves at risk (n = 489), the percentage of permanent recurrent nerve lesions was 3.1 (in the 5 most recent years it was 1.2%). There was no significant difference between total or subtotal (hemi)thyroidectomies. Initial symptomatic hypocalcemia necessitating supplementation was encountered 42 times (12.5%). The occurrence of permanent symptomatic hypocalcemia (6%) was not significantly different between total and subtotal (hemi)thyroidectomies (p = 0.06). The duration of surgery was 137.8 min for bilateral subtotal thyroidectomies and 182.9 min for bilateral total thyroidectomies (p < 0.0001). There was no difference in blood loss between total and subtotal (hemi)thyroidectomies.
Because total thyroidectomy carries a risk of complications similar to that for subtotal thyroidectomy, it is not logical to avoid total resections. If the number of total resections were increased, it is anticipated that fewer reoperations, which involve a relatively high morbidity rate, would have to be performed.
甲状腺手术的发病率较低。尽管如此，一些作者主张行甲状腺次全切除术而非全甲状腺切除术，以避免与全甲状腺切除术相关的较高发病率。
我们回顾性评估了1982年1月1日至1990年10月1日期间在莱顿进行的甲状腺手术的并发症。341例患者（261例女性和80例男性）接受了356次手术；15例患者接受了两次手术；有152例全甲状腺叶切除术、3例次全甲状腺叶切除术、33例全甲状腺切除术、122例双侧次全甲状腺叶切除术、12例全甲状腺叶切除术与次全甲状腺叶切除术的联合手术以及34例其他手术。
以有风险的神经（n = 489）计算，永久性喉返神经损伤的百分比为3.1%（最近5年为1.2%）。全甲状腺（叶）切除术或次全甲状腺（叶）切除术之间无显著差异。最初有症状的低钙血症需要补充钙剂的情况出现了42次（12.5%）。永久性有症状低钙血症的发生率（6%）在全甲状腺（叶）切除术和次全甲状腺（叶）切除术之间无显著差异（p = 0.06）。双侧次全甲状腺切除术的手术时间为137.8分钟，双侧全甲状腺切除术的手术时间为182.9分钟（p < 0.0001）。全甲状腺（叶）切除术和次全甲状腺（叶）切除术之间的失血量无差异。
由于全甲状腺切除术的并发症风险与次全甲状腺切除术相似，因此避免全切除术是不合理的。如果增加全切除术的数量，预计需要进行的再次手术（其发病率相对较高）将会减少。
