Chao T C, Jeng L B, Lin J D, Chen M F
Department of Surgery, Chang Gung Medical College, Taipei, Taiwan.
World J Surg. 1997 Jul-Aug;21(6):644-7. doi: 10.1007/s002689900287.
Reoperative thyroid surgery is an uncommon operation associated with a high complication rate. We retrospectively reviewed the data of 115 patients to study the incidence of complications after reoperative thyroid surgery. There were 107 women and 8 men (13.4:1.0) with an average age of 42.8 years (range 18-80 years). The most frequent indication for reoperation was completion thyroidectomy for a carcinoma identified by permanent sections (50 patients, 43.5%). Reoperative surgery was performed on 13 (11.3%) patients with recurrent thyroid cancer. The remaining 52 patients underwent reoperation for recurrent thyrotoxicosis (12 patients, 10.4%), recurrent nodular goiter (28 patients, 24.3%) or recurrent multinodular goiter (12 patients, 10.4%). Seven patients with recurrent nodular goiter and one patient with recurrent thyrotoxicosis underwent total thyroidectomy for the presence of malignancies that were identified by frozen sections. Overall, the interval between the initial and reoperative procedures ranged from 1 day to 33 years (2335 +/- 272 days). The length of hospital stay was 5.8 +/- 0.5 days. The length of time needed for reoperative thyroid surgery was 122.0 +/- 6.2 minutes. There was no 30-day perioperative mortality. The postoperative complications consisted of transient hypoparathyroidism in six patients (5.2%), permanent hypoparathyroidism in two patients (1.7%), transient RLN palsy in 3 patients (2.6%), and permanent recurrent laryngeal nerve palsy in two patients (1.7%). Reoperative thyroid surgery can be performed safely with little morbidity to the patient.
再次甲状腺手术是一种少见的手术，并发症发生率较高。我们回顾性分析了115例患者的数据，以研究再次甲状腺手术后并发症的发生率。其中女性107例，男性8例（13.4∶1.0），平均年龄42.8岁（范围18 - 80岁）。再次手术最常见的指征是因永久性切片确诊为癌而行甲状腺全切术（50例，43.5%）。13例（11.3%）患者因复发性甲状腺癌接受再次手术。其余52例患者因复发性甲状腺毒症（12例，10.4%）、复发性结节性甲状腺肿（28例，24.3%）或复发性多结节性甲状腺肿（12例，10.4%）接受再次手术。7例复发性结节性甲状腺肿患者和1例复发性甲状腺毒症患者因冰冻切片发现恶性肿瘤而行甲状腺全切术。总体而言，初次手术与再次手术的间隔时间为1天至33年（2335±272天）。住院时间为5.8±0.5天。再次甲状腺手术所需时间为122.0±6.2分钟。围手术期30天内无死亡病例。术后并发症包括6例（5.2%）患者出现短暂性甲状旁腺功能减退，2例（1.7%）患者出现永久性甲状旁腺功能减退，3例（2.6%）患者出现短暂性喉返神经麻痹，2例（1.7%）患者出现永久性喉返神经麻痹。再次甲状腺手术可以安全进行，对患者的损伤较小。
