甲状腺术后并发症及预防

Complications after thyroid surgery and their prevention

因甲状腺解剖结构、毗邻关系复杂,手术操作难度大,术后可能出现甲状旁腺功能低下、喉返及喉上神经损伤、乳糜漏、出血等一系列并发症,严重影响患者术后生活质量。手术操作的规范化、标准化是避免甲状腺术后并发症的关键。其中甲状旁腺功能低下和喉返神经损伤是甲状腺手术最常见的严重并发症,如何预防尤为重要。精细化被膜解剖技术是有效降低上述并发症的技术保障。现有的甲状旁腺分型及原位保留、纳米炭甲状旁腺负显影辨认保护技术、"两保留"的中央区淋巴结清扫、策略性甲状旁腺自体移植等可有效降低术后甲状旁腺功能低下的风险。而术中喉返、喉上神经监测以及双极电凝镊的使用与传统结扎法相结合等方法也能有效避免喉返、喉上神经的损伤。本文重点回顾现有的临床数据,对甲状腺术后并发症及目前主要的预防手段进行归纳总结。

Due to the complex anatomical structure and adjacent relationship of the thyroid, thyroid surgery is difficult and a series of complications might occur after surgery, including hypoparathyroidism, injury of the recurrent laryngeal and superior laryngeal nerves, chyle leak, and bleeding, which seriously affects the quality of life of patients after surgery. Standardization of surgical operation is the key to avoiding complications after thyroid surgery.Hypoparathyroidism and recurrent laryngeal nerve injury are the two most common complications of thyroid surgery,and it is of particular importance to prevent these two complications. Meticulous capsular dissection is considered the technical support for effectively reducing such complications. Existing methods of parathyroid anatomical typing and in situ preservation, nano-carbon parathyroid negative imaging technique, central lymph node dissection with"two reservations", and strategic parathyroid autotransplantation can effectively reduce the risk of hypoparathyroidism after surgery. In addition, monitoring of the recurrent/superior laryngeal nerve and application of bipolar electrocoagulation forceps combined with traditional ligation can effectively avoid the injury of the recurrent/superior laryngeal nerve. This article summarizes the complications after thyroid surgery and main preventive measures by reviewing existing clinical data.