甲状腺全切除术治疗甲状腺良性疾病

目的　探讨甲状腺全切除术治疗甲状腺良性疾病的安全性和临床意义。方法　对 88例甲状腺良性疾病患者进行甲状腺全切除术 ,并对手术并发症进行分析。结果　首次甲状腺全切除术暂时性甲状旁腺功能低下和暂时性喉返神经损伤的发生率分别为 2 .5 %和 1.2 % ,再次手术的并发症明显增高 ,分别为 2 8.6 % (P<0 .0 5 )和2 8.6 % (P<0 .0 1)。术后患者均未发生永久性甲状旁腺功能低下和永久性喉返神经损伤。结论　首次甲状腺全切除术安全可行 ,能避免因组织残留所致的病变复发 ,降低再手术率     

甲状腺全切除术治疗良性甲状腺疾病临床价值的研究

目的:探讨甲状腺全切除术治疗甲状腺良性疾病的价值及临床意义。方法:回顾分析我院2005年3月～2007年3月收治的169例行甲状腺全切除术的甲状腺良性疾病患者临床病理资料,并对其术后并发症进行分析总结。结果:首次甲状腺全切除术后暂时性甲状旁腺功能低下和暂时性喉返神经损伤的发生率分别为0.76%和1.52%,再次手术的并发症明显增高,分别为40.54%和32.43%,P<0.01。术后患者均未发生永久性甲状旁腺功能低下和永久性喉返神经损伤。结论:甲状腺全切除术治疗良性甲状腺疾病能避免组织残留所致的病变复发和癌变,降低再手术率,且首次手术较再次手术的并发症率低,但需在术中精细操作。     

甲状腺癌患者甲状腺全切手术安全性探讨

目的 探讨甲状腺癌患者行甲状腺全切除手术的安全性.方法 回顾性分析1986年1月至2006年12月因甲状腺癌行甲状腺全切除(全切组)以及次全或近全切除术(双叶手术组)的患者资料,比较两组间喉返神经损伤和继发性甲状旁腺功能低下的发生率.结果 双叶切除手术组433例:13例发生暂时性单侧喉返神经损伤,5例发生永久性单侧喉返神经损伤;11例发生暂时性甲状旁腺功能低下,无永久性甲状旁腺功能下病例.甲状腺全切手术组共70例:4例发生暂时性单侧喉返神经损伤(P>0.05),1例发生永久性单侧喉返神经损伤(P>0.05);7例发生暂时性甲状旁腺功能低下(P<0.01),2例永久性甲状旁腺功能低下(P<0.05).结论 甲状腺全切除术并不增加喉返神经损伤的概率,但手术后甲状旁腺功能低下发生率增加,因此应该有选择的施行甲状腺全切除手术.     

甲状腺再手术并发症的预防

目的 探讨甲状腺再手术的技术要点及其术后并发症的预防,重点讨论再手术入路,喉返神经和甲状旁腺的保护.方法 回顾性分析183例甲状腺再手术的临床资料,其中恶性肿瘤再手术68例,良性疾病再手术115例,探讨各种手术入路,并对术后并发症进行分析.结果 暂时性甲状旁腺功能低下发生率为4.37%(8/183),永久性甲状旁腺损伤发生率为0.55%(1/183),暂时性喉返神经损伤发生率为4.92%(9/183),永久性喉返神经损伤发生率为1.64%(3/183),术后再出血发生率为0.55%(1/183).结论 甲状腺再手术难度大,其成功的关键在熟悉解剖、掌握术中操作技巧、小心谨慎及灵活机动.     

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目的 探讨甲状腺全切除术中技术要点及其术后并发症的防治方法。重点讨论甲状旁腺及喉返神经的保护。方法 对84例分化型甲门面腺癌病人进行甲状腺全切除术,对术后并发症进行观察。结果 暂时性甲状旁腺功能低下发生率为13.10%,暂时性单侧喉返神经损伤的发病率为10.98%。结论 甲状腺全切除术安全,可行,关键在于术中的操作。使术后并发症降至最低。     

甲状腺良性病变再手术的原因和预防分析

目的 探讨甲状腺再次手术并发症的预防及避免再次手术的方法.方法 回顾性分析2000年4月至2010年4月因甲状腺良性病变行甲状腺次全切除术583例和再手术行甲状腺次全切除者85 例的临床资料.结果 再手术时暂时性喉返神经损伤发生率为8.2%,高于首次手术的2.9%(P<0.05);暂时性甲状旁腺功能低下发生率为7.0%,亦高于首次手术的1.7%(P<0.05).结论 甲状腺再手术可以安全进行,经细致操作,并发症发生率仍较高.如果首次手术选择甲状腺全切,可避免再次手术.     

结节性甲状腺肿甲状腺全切除术46例临床分析

目的分析结节性甲状腺肿甲状腺全切除术的临床价值。方法收集2017-01—2019-01间在浚县人民医院接受甲状腺全切除术的46例结节性甲状腺肿患者。对其临床资料进行回顾性分析。结果术后出现暂时性甲状旁腺功能低下1例,暂时性喉返神经损伤2例。经对症处理后分别于术后第3天、7天、10天恢复正常。随访3个月,未发生永久性甲状旁腺功能低下和喉返神经损伤。其间复查彩超未见甲状腺组织残留。口服优甲乐100μg/d,甲功3项均在正常范围。结论在把握好手术适应证、熟练掌握喉返神经及甲状旁腺的位置比邻、精准进行手术操作的前提下,对结节性甲状腺肿患者实施甲状腺全切除术,具有重要临床价值。     

162例甲状腺大部切除术的临床体会

目的:总结162例甲状腺大部切除术的手术经验。方法:对共治疗各种良性甲状腺疾病162例的临床资料进行回顾性分析。结果:暂时性喉返神经损伤4例,喉上神经损伤1例,术后3d~3月恢复功能;暂时性甲状旁腺功能低下1例,术后5d恢复正常,无手术死亡及甲状腺危象。结论:手术时间短,损伤小,并发症少,恢复快,切口符合美观要求,临床效果好。     

腔镜甲状腺手术致喉返神经损伤及其预防

由于喉返神经的位置与甲状腺下动脉关系紧密，又无恒定的解剖关系，因此在开放甲状腺手术中，喉返神经损伤是甲状腺手术比较常见的并发症，国外文献报道发生率为2％～17％。国内报道甲状腺腺叶切除术后喉返神经暂时性损伤达10．8％，永久性损伤的发生率为0．2％拉0。喉返神经损伤可致术后声嘶、呛咳、窒息，甚至危及生命，故预防喉返神经损伤具有重要意义。喉返神经损伤原因多为：切断、被结扎、过度牵拉、术后组织水肿、血肿压迫、瘢痕压迫等。本文就腔镜甲状腺手术致喉返神经暂时性损伤的特点及其预防做一探讨。[第一段]     

甲状腺癌患者再次手术49例分析

目的探讨甲状腺癌再次手术的技术要点，重点讨论手术入路与术式，喉返神经和甲状旁腺的保护及其并发症的预防。方法回顾性分析2000年1月至2007年12月127例甲状腺再次手术的临床资料，其中因甲状腺癌而再手术49例，对各种人路与术式及术后并发症进行分析。结果暂时性甲状旁腺功能低下率为4％，永久性甲状旁腺损伤率为2％，暂时性喉返神经损伤率为6，久性喉返神经损伤率为2％，术后再出血率为2％。结论甲状腺癌再次手术难度大，其成功实施的关键在于术中操作技巧。     

Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions

HYPOTHESIS: Near-total thyroidectomy, on the basis of its low morbidity rate, is an appropriate treatment option in the surgical management of various thyroid diseases in an endemic region in Turkey. DESIGN: Single-institution study of patients with various thyroid diseases treated by means of near-total thyroidectomy within 2 years in an endemic region, with comparison of the results vs the complication rates of bilateral subtotal and total thyroidectomy reported in the literature. SETTING: Tertiary academic referral center. PATIENTS: One hundred fifty-two patients who underwent near-total thyroidectomy for various thyroid diseases. MAIN OUTCOME MEASURES: Surgical treatments of various benign thyroid diseases were compared according to the complication rates and the achievable benefits of the procedures. RESULTS: In our clinic, near-total thyroidectomy was the principal surgical procedure performed for benign thyroid disease. The temporary recurrent laryngeal nerve palsy rate with respect to the nerves at risk was 3.3% (10 of 304 nerves), whereas temporary hypoparathyroidism was 7.2% (11 of 152 patients). Neither permanent recurrent laryngeal nerve palsy nor permanent hypoparathyroidism occurred. In 1 patient, wound hematoma developed and required re-exploration. Seroma in another patient needed no medical or surgical intervention. Neither wound infection nor mortality were noted. CONCLUSIONS: Near-total thyroidectomy achieves a lower complication rate of hypoparathyroidism and a similar complication rate of recurrent laryngeal nerve palsy and recurrence when compared with the rates reported in the literature for total thyroidectomy. It is an effective and safe surgical treatment option for various benign thyroid diseases.     

甲状腺全切除术的适应证及安全性分析

目的探讨甲状腺全切术的手术适应证以及并发症的防治。方法回顾性分析2009年1月至2011年12月期间在笔者所在医院接受甲状腺全切除术的85例患者的临床资料。85例中甲状腺癌46例,结节性甲状腺肿38例,桥本甲状腺炎1例。分析其手术过程以及术后并发症。结果术后病理检查提示46例甲状腺癌中9例（19.6%）为双侧癌;38例结节性甲状腺肿患者均为双侧多发结节。全部患者均解剖出2条喉返神经,有4例患者的喉返神经被肿瘤侵犯,其中1条喉返神经被切除。有5例患者术中未能明确看到并保留甲状旁腺,其余患者均保留了1枚或以上的甲状旁腺。有2例患者术后发生出血需再次手术止血;有6例患者术后出现声音嘶哑,除1例喉返神经被切除者之外,其余患者声音均恢复正常;33例（38.8%）患者出现一过性低钙血症症状;2例患者出现永久性甲状旁腺功能低下。结论甲状腺全切除术是治疗双侧结节性甲状腺肿和甲状腺癌的安全术式,术中显露喉返神经与鉴别甲状旁腺可有效防止相应并发症的发生。肿瘤侵犯喉返神经并不一定导致患者声音嘶哑。     

Recurrent nerve palsy and hypocalcemia after surgery of benign thyroid diseases

Summary Background A critical analysis of early and late postoperative complications is necessary to assure the quality of surgery for benign thyroid diseases. The 2 major complications are palsy of the recurrent laryngeal nerve and hypoparathyroidism. Yet, long-term and follow up studies. as well as pre and post operative investigations are rather scarce. Methods 3246 patients operated on for benign thyroid diseases between 4/86 and 12/93 were retrospectively screened and analyzed for early postoperative recurrent laryngeal nerve palsy and hypoparathyroidism. Permanent laryngeal nerve paralysis and hypocalcemia was investigated by sending questionnaires to these patients and their physicians. Results 88 patients (2.7%) had aerly postoperative laryngeal nerve palsy. 58 (1.78%) of them recovered completely. reducing the cases of permanent paralysis to 30 patients (0.92%), 22 of which had proven (0.68%) permanent recurrent laryngeal nerve paralysis. The 8 questionable cases (0.24%) could not be evaluated. Hypoparathyroidism necessitating calcium and/or vitamin D-treatment for more than 2 years was present in 18 patients (0.6%), which were without symptoms under this medication. Conclusions Dissecting the recurrent laryngeal nerve and visualizing the parathyroid glands during surgery for benign thyroid diseases decrease nerve paralysis and hypoparathyroidism to a permanent prevalence of less than 1%.      

Postoperative Complications of Thyroidectomy: A Comparison of Two Series at an Interval of Ten Years1

A comparison is presented of the complications found in two series each consisting of 331 consecutive patients undergoing thyroidectomy in the same Unit ten years apart. The overall incidence of postoperative complications has been reduced, particularly in the group of patients having thyroidectomy for thyrotoxicosis, following which it is now no greater than after thyroidectomy for benign non-toxic goitre. The techniques used to try to reduce the postoperative complication rate are discussed. The incidence of permanent recurrent laryngeal nerve palsy has been reduced to 0–3% and of permanent hypoparathyroidism to 1.2/. The overall incidence of complications causing permanent disability is now 3–9%     

Total thyroidectomy for clinically benign disease of the thyroid gland

BACKGROUND: The role of total thyroidectomy in the treatment of patients with benign thyroid disease remains controversial. However, this procedure may be appropriate when both thyroid lobes are involved and when the risk of recurrence is significant. This study is a review of a 15-year experience of total thyroidectomy for benign disease. METHODS: Between 1988 and 2002, 834 patients underwent total thyroidectomy for clinically benign disease at the Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital. There were 128 men and 706 women with a mean age of 52 (range 16-91) years. Indications for surgery were euthyroid multinodular goitre (MNG), toxic MNG and Graves' disease in 730 (87.5 per cent), 57 (6.8 per cent) and 47 (5.6 per cent) respectively. A total of 74 patients had previously undergone partial thyroidectomy. RESULTS: The incidence of temporary recurrent laryngeal nerve palsy was 2.3 per cent and that of temporary hypoparathyroidism 14.4 per cent. Permanent recurrent laryngeal nerve palsy occurred in 1.1 per cent, and 2.4 per cent of patients had permanent hypoparathyroidism. Neither the initial clinical diagnosis nor a history of previous treatment significantly influenced the rate of complications. The incidence of malignancy, other than incidental microscopic papillary carcinoma, was 4.6 per cent. CONCLUSION: Total thyroidectomy has an important role in the management of patients with benign disease when both lobes of the thyroid gland are involved. This approach avoids disease recurrence and the increased risk of morbidity associated with secondary operation.     

Emergencies in thyroid surgery. Our experience

The rate of complications after thyroid surgery is about 5% and among these real emergencies account for less than 1%, consisting in intraoperative and postoperative bleeding, bilateral recurrent palsy, severe hypoparathyroidism and, rarely, laryngeal oedema and tracheomalacia. Between 2000 and 2004 849 patients were submitted to total thyroidectomy for various thyroid pathologies in our institution. Complications observed were postoperative bleeding in 13 patients (1.5%), laryngeal recurrent nerve palsy in 18 (monolateral in 14 - 8 transient and 6 permanent - and bilateral in 4, 3 of which transient), transient hypoparathyroidism in 390 (45.9%), permanent hypoparathyroidism in 10 (out of 400 patients followed up for more than one year = 2.5%). Tetanic crises were observed in 33 patients (3.9%). One patient, on treatment with heparin, showed a glottic haemorrhagic oedema (probably caused by trauma after endotracheal intubation) treated by an emergency tracheotomy on postoperative day two. Thyroid surgery is today very safe and morbidity is rare. Anatomical knowledge and accuracy of surgical indications are the main factors capable of reducing the number of complications. Experience in performing thyroid surgery is essential for the best outcome with the fewest complications. Complications of total thyroidectomy can be minimised with increasing experience and refinement of surgical technique.     

完全囊外甲状腺切除术的术式探讨

目的探讨完全囊外甲状腺切除的手术技巧。方法回顾性分析 10 4例完全囊外甲状腺切除术的结果。结果　从 1990年 5月至 2 0 0 0年 5月 10年间以完全囊外的入路行甲状腺次全或全切除 10 4例 ,患者无术后危象、术后出血致呼吸道梗阻、永久性甲状旁腺低功等严重并发症 ,仅1例出现暂时性喉返神经麻痹。结论完全囊外甲状腺切除术出血少 ,并发症少 ,安全 ,效果好 ,是理想的手术入路。     

Complications of thyroid surgery performed by residents

The purpose of this report is to study the incidence of complications in thyroid surgery performed by the residents in a surgical training program. This is a report of complications in 200 consecutive thyroidectomies performed by residents with attending surgeons' assistance. There were 128 female and 72 male patients, ranging in age from 16 to 89 years. Ten patients had undergone previous thyroid surgery. There were 40 total thyroidectomies, 38 subtotal thyroidectomies, and 122 lobectomies with isthmusectomy. Preoperative and postoperative evaluation of the vocal cords was a standard routine. Identification of the recurrent laryngeal nerve was routine except in patients with large goiters, who underwent intracapsular subtotal thyroidectomy. An attempt was made to identify and preserve all four parathyroid glands. Even in lobectomy procedures, the ipsilateral parathyroids were identified and preserved. Parathyroid autotransplantation into the sternomastoid muscle was performed in thirteen instances, whenever any of the parathyroids was devascularized. Complications included superior laryngeal nerve palsy (one case) and temporary recurrent laryngeal nerve palsy (one case). There was only one patient in whom temporary hypoparathyroidism developed. In three patients hematomas developed in the recovery room and reexploration was required. Two diabetic patients had wound infections develop that required drainage. Seromas and minor wound collections were noted in 6% of the patients. The incidence of major postoperative complications of thyroidectomy is low, even when residents are the primary surgeons. Thyroidectomy appears to be a safe operation in the hands of residents with close supervision and assistance by the attending surgeons.     

Importance of identifying the course of the recurrent laryngeal nerve in total and near-total thyroid lobectomies

In our clinic, near-total thyroidectomy is the principal surgical procedure performed for benign thyroid diseases. We conducted a single-institution study on 176 consecutive patients who underwent near-total thyroidectomy due to various thyroid diseases. We compared the incidence of recurrent laryngeal nerve injury between total and near-total thyroid lobectomy sides in each patient. Our hypothesis was that the incidence of recurrent laryngeal nerve injury after total thyroid lobectomy would be similar to that of near-total thyroid lobectomy when the course of the recurrent laryngeal nerve was identified during surgery. The temporary recurrent laryngeal nerve palsy rates on the total and near-total thyroid lobectomy sides were 3.9 per cent (7 of 176 nerves) and 2.2 per cent (4 of 176 nerves), respectively. The difference was not statistically significant. Permanent recurrent laryngeal nerve palsy did not occur in any of our patients. In conclusion, the incidence of recurrent laryngeal nerve injury in total versus near-total thyroid lobectomy is not different when the course of the recurrent laryngeal nerve is identified during surgery.