Bergamaschi R, Becouarn G, Ronceray J, Arnaud J P
Department of Visceral Surgery, Angers University Hospital, France.
Am J Surg. 1998 Jul;176(1):71-5. doi: 10.1016/s0002-9610(98)00099-3.
Morbidity is today's concern in thyroid surgery. The purpose of this paper was to quantify risk factors' contribution to morbidity rates.
During 50 months, 1,163 patients undergoing 1,192 thyroidectomies at one hospital were reviewed at follow-up of 8 to 58 months.
There was 1 death (0.08%). Wound morbidity included 19 hematomas (1.6%), 3 chyle leaks (0.2%), and 6 abscesses (0.5%). Mean hospital stay was 4.3 days after surgery without drain and 5.3 days with drain (P < 0.01). Temporary and permanent hypoparathyroidism (TH; PH) rates were 20% and 4%. Parathyroid autografting and excision rates were 19% and 9%. TH rates were higher after parathyroid autografting or accidental excision (P < 0.01). There was no correlation between the severity of TH and the number of lymph nodes at neck dissection nor between postoperative serum calcium levels and the number of parathyroids identified at bilateral surgery. Temporary and permanent recurrent laryngeal nerve (RLN) palsy (TRLNP; PRLNP) rates were 2.9% and 0.5% (0.3% of 2,010 RLNs at risk). PH and TRLNP (not PRLNP) rates were higher after completion or total thyroidectomy with node dissection (P < 0.01). TRLNP and PRLNP rates after RLN exposure and after nonexposure were not statistically different. Surgical volume had no bearing on hematoma, abscess, TH, PH, TRLNP, and PRLNP rates.
High surgical volume, identifying parathyroids and RLNs, failed to reduce morbidity. Completion and total thyroidectomy with node dissection increased PH and TRLNP (not PRLNP) rates.
甲状腺手术的发病率是当今备受关注的问题。本文旨在量化风险因素对发病率的影响。
在50个月期间，对一家医院1163例接受1192次甲状腺切除术的患者进行了回顾性研究，随访时间为8至58个月。
有1例死亡（0.08%）。伤口并发症包括19例血肿（1.6%）、3例乳糜漏（0.2%）和6例脓肿（0.5%）。术后无引流管时平均住院天数为4.3天，有引流管时为5.3天（P<0.01）。暂时性和永久性甲状旁腺功能减退（TH；PH）发生率分别为20%和4%。甲状旁腺自体移植率和切除率分别为19%和9%。甲状旁腺自体移植或意外切除后TH发生率更高（P<0.01）。TH的严重程度与颈部清扫术的淋巴结数量之间、术后血清钙水平与双侧手术中识别出的甲状旁腺数量之间均无相关性。暂时性和永久性喉返神经（RLN）麻痹（TRLNP；PRLNP）发生率分别为2.9%和0.5%（在2010条有风险的RLN中占0.3%）。完成或全甲状腺切除并进行淋巴结清扫术后PH和TRLNP（而非PRLNP）发生率更高（P<0.01）。RLN暴露后与未暴露后的TRLNP和PRLNP发生率无统计学差异。手术量与血肿、脓肿、TH、PH、TRLNP和PRLNP发生率无关。
高手术量、识别甲状旁腺和RLN并不能降低发病率。完成和全甲状腺切除并进行淋巴结清扫会增加PH和TRLNP（而非PRLNP）发生率。
