甲状腺外科专业化的临床资料分析

目的 评价耳鼻咽喉头颈外科医师手术治疗甲状腺良性疾病的结果。方法回顾性分析北京朝阳医院耳鼻咽喉头颈外科2001年1月-2004年4月手术治疗496例甲状腺良性疾病的方式、术后并发症的发生、手术耗时、颈部切口长度、住院时间和术后复发的情况。结果甲状腺一侧腺叶加对侧腺叶部分切除314例，甲状腺一侧腺叶加峡部切除76例，甲状腺双侧腺叶次全切除29例，单纯甲状腺峡部切除3例，甲状腺全切除46例，颈部低位领式切口入路切除胸骨后结节性甲状腺肿28例。术后一侧喉返神经损伤发生率为0．2％(1／496)，无双侧喉返神经损伤。术后暂时性低钙血症发生率为1．8％(9／496)，无永久性低钙血症。术后出血发生率为0．6％(3／496)，无切口感染。手术耗时平均为66min，颈部切口长度平均为5．2cm，住院时间平均为6．3d。术后复发率0．2％(1／496)。结论受过严格头颈外科培训的耳鼻咽喉科医师行甲状腺良性疾病手术可降低喉返神经损伤的发生。

Specialization in thyroid surgery

Objective To evaluate the results of surgically treated patients with benign thyroid disorders from Department of Otolaryngology- Head and Neck Surgery. Methods The clinical data of 496 patients operated for benign thyroid disorders were retrospectively analyzed in this department from January 2001 to April 2004. The incidence of complications, particularly postoperative permanent recurrent laryngeal nerve palsy and hypocalcemia, duration of surgery, incision length on the neck, hospitalization days and postoperative recurrence were evaluated. Results Unilateral total thyroidectomy with contralateral partial lobectomy was performed in 314 cases, unilateral total thyroidectomy with isthmectomy in 76, bilateral subtotal thyroidectomy with the remnant left at the upper pole in 29, isthmectomy in 3, total thyroidectomy in 46. The operations on 28 patients with substernal goiter have been successfully performed via cervical collar incision. Of these patients, the incidences of unilateral recurrent laryngeal nerve paralysis and temporary postoperative hypocalcemia were 0.2%(1/496) and 1.8%(9/496), respectively. There were no bilateral vocal cord paralyses and permanent hypocalcaemia. Postoperative hemorrhage requiring reoperation occurred in 3 cases (0.6%). No patients had incision infection. The mean duration of surgery was 66 min. The mean incision length on the neck was 5.2 cm. The incidence of postoperative recurrence was 0.2%((1/496).) The mean hospitalization day was 6.3 d. Conclusions Otolaryngologists who had received stringent training of head and neck surgery seem to have the advantage to avoid injury of recurrent nerve in the thyroid surgery.