Wilson D B, Staren E D, Prinz R A
Department of General Surgery, Rush Medical College, Chicago, Illinois 60612-3833, USA.
Am Surg. 1998 Jul;64(7):674-8; discussion 678-9.
Thyroid reoperations can be technically difficult and associated with an increased risk of complications. To determine the indications for reoperations and the risk of postoperative complications with these procedures, records of 362 patients undergoing thyroidectomy by a single surgeon (R.A.P.) were reviewed. Thirty-two patients had a reoperation. The group consists of 21 women and 11 men with an average age of 55 years (range, 31-79). Twenty-four patients had 1 prior operation, and 8 patients had 2 or more. We performed 4 of the initial operations, and 28 were done by surgeons at other centers. Fourteen reoperations were done for symptomatic multinodular goiter (MNG), and 5 because of a change in the histologic diagnosis from benign to cancerous. The remainder were for further treatment of malignancy. The most common operation was completion thyroidectomy (31). In 3 patients, either unilateral or bilateral modified radical neck exploration was performed. One patient required median sternotomy. One subtotal thyroidectomy was also performed. Recurrent laryngeal nerve injury occurred in 2 patients. It resolved in 1 patient but was permanent in another, who had 3 operations for MNG. One of the 2 patients with preoperative unilateral vocal cord paralysis had return of function after removal of a substernal goiter. The other had a permanent nerve injury from the original surgery. Three patients had postoperative hypocalcemia (calcium <8.0 mg/dL). This resolved in all patients within 1 to 6 months. One patient who had a third operation for MNG had postoperative hemorrhage necessitating tracheostomy for airway control. Another patient developed a seroma that resolved within 2 months. We conclude that reoperations are indicated for both benign and malignant thyroid disease. Because they carry a higher risk of complications, every effort should be made to avoid them by performing definitive initial treatment.
甲状腺再次手术在技术上可能具有挑战性，且并发症风险会增加。为了确定再次手术的指征以及这些手术术后并发症的风险，我们回顾了由单一外科医生（R.A.P.）实施甲状腺切除术的362例患者的记录。其中32例患者接受了再次手术。该组包括21名女性和11名男性，平均年龄55岁（范围31 - 79岁）。24例患者曾接受过1次手术，8例患者曾接受过2次或更多次手术。我们实施了4例初次手术，其余28例由其他中心的外科医生完成。14例再次手术是针对有症状的结节性甲状腺肿（MNG），5例是因为组织学诊断从良性变为癌性。其余的是针对恶性肿瘤的进一步治疗。最常见的手术是甲状腺全切术（31例）。3例患者进行了单侧或双侧改良根治性颈部探查。1例患者需要正中胸骨切开术。还实施了1例次全甲状腺切除术。2例患者发生了喉返神经损伤。1例患者的损伤得到恢复，但另1例为永久性损伤，该患者因MNG接受了3次手术。2例术前单侧声带麻痹的患者中，1例在切除胸骨后甲状腺肿后功能恢复。另1例患者因初次手术导致永久性神经损伤。3例患者术后出现低钙血症（血钙<8.0mg/dL）。所有患者均在1至6个月内恢复。1例因MNG接受第三次手术的患者术后出血，需要气管切开以控制气道。另1例患者出现血清肿，在2个月内消退。我们得出结论，无论是良性还是恶性甲状腺疾病都需要再次手术。由于再次手术并发症风险更高，应尽一切努力通过进行明确的初次治疗来避免再次手术。
