Seiler C A, Glaser C, Wagner H E
Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Switzerland.
World J Surg. 1996 Jun;20(5):593-6; discussion 596-7. doi: 10.1007/s002689900092.
To assess the incidence, indications, and complications of (reoperative) thyroid gland surgery in an endemic region, we have retrospectively analyzed 1318 patients operated on between 1983 and 1994. There were 166 reoperations (13.5%). In comparison to the primary operation the indication for reoperation showed an increased rate of premalignant and malignant tumors (+16%) and a decreased rate of hyperthyroid disorders (-30%). The largest group operated on had benign multinodular goiters, with the same rate of indication for primary (57.4%) and secondary (57.8%) surgery. Permanent recurrent laryngeal nerve palsy rate following primary operation occurred at rates of 1.7% (1983-1990) and 0.7% (1991-1994) and for secondary operation 3.5% (1983-1990) and 5.6% (1991-1994), respectively. The change in recurrent nerve palsy rate in the later years was due to a more extensive resection policy at the primary operation and a more liberal approach to reoperative surgery. The high rate of reoperation for benign goiters (13%) and the new data of goitrogenesis have therefore directed our policy to more extensive resection of the thyroid tissue at the initial operation, increasing the rate of lobectomy from 27% (1982-1990) to > 90% (1991-1994) and at the same time lowering morbidity. Extensive resection of nodular tissue during the initial operation safely reduces the incidence of recurrent goiter and subsequently reduces the rate of reoperation and eliminates the high risk of morbidity associated with reoperative thyroid surgery. The indications for reoperation should be strict, and when unavoidable a modified lateral approach may be helpful.
为评估地方性甲状腺肿流行地区（再次）甲状腺手术的发生率、手术指征及并发症，我们回顾性分析了1983年至1994年间接受手术的1318例患者。其中有166例再次手术（13.5%）。与初次手术相比，再次手术的指征显示癌前病变和恶性肿瘤的发生率增加（+16%），甲状腺功能亢进症的发生率降低（-30%）。接受手术的最大群体为良性多结节性甲状腺肿，初次手术（57.4%）和二次手术（57.8%）的指征发生率相同。初次手术后永久性喉返神经麻痹发生率在1983 - 1990年为1.7%，1991 - 1994年为0.7%；二次手术在1983 - 1990年为3.5%，1991 - 1994年为5.6%。后期喉返神经麻痹发生率的变化是由于初次手术时采用了更广泛的切除策略以及二次手术采用了更宽松的手术方法。因此，良性甲状腺肿的高再次手术率（13%）和甲状腺肿发生的新数据促使我们在初次手术时采取更广泛切除甲状腺组织的策略，将叶切除术的比例从1982 - 1990年的27%提高到1991 - 1994年的>90%，同时降低发病率。初次手术时广泛切除结节组织可安全降低复发性甲状腺肿的发生率，进而降低再次手术率，并消除再次甲状腺手术相关的高发病风险。再次手术的指征应严格，不可避免时采用改良外侧入路可能会有帮助。
