甲状腺全切除术的手术并发症分析

Surgical complications of total thyroidectomy

目的探讨甲状腺全切除术(TT)的手术并发症及其影响因素。方法回顾性分析2007年1月—2 0 0 9年1 2月在手术放大镜下行TT的1 7 2例患者临床资料,统计术中及术后并发症的发生情况,分析可能影响TT术后并发症的相关因素。结果全组术中甲状旁腺显露率96.5%,喉返神经显露率98.3%。初治患者旁腺显露率高于再次手术者(98.7%vs.77.7%)(P<0.05);术后平均血钙浓度较术前明显下降[(2.057±0.016)mmol/L vs.(2.347±0.009)mmol/L](P<0.01);全组术后暂时性甲状旁腺功能减退发生率为16.9%(29/172),永久性甲状旁腺功能减退发生率为1.2%(2/172),再次手术者术后永久性甲状旁腺功能减退发生率高于初治者(11.1%vs.0)(P<0.01)。术后出现永久性喉返神经麻痹1例(0.6%)。结论使用手术放大镜,在精细解剖的基础上行TT安全性好,并发症发生率低,值得提倡。

Objective To investigate the surgical complications of total thyroidectomy （TT） and their associated risk factors. Methods The clinical data of 172 patients who undm^ent TT under surgical loupes from January 2007 to December 2009 in our hospital were retrospectively reviewed. The intraoperative and postoperative complications were recorded and the possible factors responsible for surgical complications of TT were analyzed. Results Of the whole group, the exposure rate of the parathyroid glands and the recurrent laryngeal nerves was 96.5 % and 98.3 % , respectively. The exposure rate of the parathyroid glands of the patients undergoing primary surgery was higher than that of the patients undergoing secondary surgery （ 98.7% vs. 77.7% ） （ P 〈 0.05 ） . The average serum calcium level after surgery decreased significantly compared with that before surgery [ （2.057 ±0.016） mmol/Lvs. （2.347 ±0.009） mmol/L （P〈0.01）. In the whole group, the incidence of transient and permanent hypoparathyroidism was 16. 9% and 1. 2% , respectively. The incidence of permanent hypoparathyroidism in the patients undergoing secondary surgery was significantly higher than that in the patients undergoing primary surgery （ 11. 1% vs. 0 ） （ P 〈 0.01 ） . The permanent recurrent laryngeal nerve palsy oecmxed in one case （ 0. 6 % ）. Conclusions TT is a safe procedure with low complication rate under the condition of meticulous dissection with the aid of surgical loupes, and is recommended for use in clinical practice.