Hypothyroidism is one of the focuses of attention in the field of thyroid surgery, but postoperative hypoparathyroidism has always been an unavoidable complication for surgeons. Currently, there is still controversy over the definition and classification of postoperative hypoparathyroidism, and there are significant differences in the definition and incidence of permanent hypoparathyroidism among different studies. The author provides preliminary suggestions and ideas for the diagnosis and definition of hypoparathyroidism based on relevant guidelines, literature, and clinical experience, in order to provide more accurate diagnosis and treatment plans for postoperative hypoparathyroidism.
Thyroid disease is more common in young women. Traditional surgical scars may affect the appearance of patients and cannot fully meet the cosmetic needs of patients. With the advancement of surgical techniques, endoscopic thyroid surgery has developed rapidly. Trans oral endoscopic thyroidectomy vestibular approach is feasible and safe to achieve no scar on the body surface, but there are some unavoidable limitations, such as postoperative numbness and discomfort in the center of the chin region. As a new approach to thyroid surgery, trans oral endoscopic thyroidectomy submental access has the same advantages as the trans oral vestibular approach from top to bottom, and can reliably and thoroughly dissect lymph nodes in the central area (especially area Ⅶ), allowing larger specimens to be taken out and expands the indications for surgery, minimizes flap detachment, and avoids jaw pain and numbness. Trans oral endoscopic thyroidectomy submental access is an innovation in the concept of thyroid surgery, which achieves minimally invasive and aesthetic results on the premise of ensuring the quality of the surgery and curing the disease. We reviewed the history, advantages and disadvantages of trans oral endoscopic thyroidectomy submental access.
ObjectiveTo summarize the risk factors of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury and to provide reference for the prevention and treatment of postoperative voice quality damages.MethodThe research progress of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was reviewed by reading the related literatures at home and abroad.ResultsEven if there was no obvious recurrent laryngeal nerve injury during the operation, the voice quality may change after the operation for the patients undergoing thyroidectomy. The change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was associated with various risk factors such as dysfunction of superior laryngeal nerve, injury of anterior laryngeal band muscles, endotracheal intubation, surgical methods, age, gender and special occupations.ConclusionsThe change of voice quality is a common complication after thyroidectomy, which seriously affects the quality of life of patients. In the absence of significant recurrent laryngeal nerve injury, many patients will still experience problems with voice quality. Understanding the related risk factors of voice quality change after thyroidectomy is helpful to optimize postoperative voice function, to prevent possible secondary injuries, and to improve the quality of life of patients.
目的 总结临床经验，提高诊治水平。方法 总结我院1992年4月至1998年6月期间5例甲状腺术后癔病性搐搦的临床资料。结果 5例均为女性，术前血清钙、磷浓度正常，无癫痫史。4例行甲状腺侧叶加峡部切除术，1例行甲状舌骨囊肿切除术。4例于术后1小时50分至3小时20分突发手足搐搦。1例术后5小时25分出现手腕以远麻木。查体： Chvostek氏征及Troussetau氏征阴性，急查血清钙、磷及PTH浓度正常，静脉补钙无效。结论 甲状腺术后出现搐搦，如补钙无效，应考虑癔病的可能。其特点为： 女性，具有一定的文化知识，发病时间早，血清钙、磷及PTH正常，静脉补钙无效，需用心理暗示及镇静治疗。
Objective To investigate the indications and prevention of complications of total thyroidectomy in the management of thyroid diseases. Methods Eighty five patients who received total thyroidectomy between Jan. 2009 and Dec. 2011 were retrospectively analyzed with regard to the surgical procedures and postoperative complications. There were 46 thyroid cancers， 38 nodular goiters， and 1 Hashimoto thyroiditis. Results The postoperative pathological exam-inations revealed that 9 （19.6%） of 46 thyroid cancers were bilateral， and all of nodular goiters were also bilateral multiple nodule. Bilateral recurrent laryngeal nerves were exposed in all of the patients in which 4 recurrent laryngeal nerves were invaded by cancer and 1 was sacrificed. There were 5 patients whose parathyroids were not identified and protected during the operation. Two patients developed postoperative bleeding and needed reoperation， 6 patients developed hoarseness of whom 5 patients recovered except for the one whose nerve was sacrificed. And in terms of hypoparathyroidism， 33 （38.8%） patients developed transient hypocalcemia related symptoms. The permanent hypoparathyroidism occurred only in 2 patients. Conclusions Total thyroidectomy is a safe procedure in the management of thyroid cancer and bilateral nodular goiter. Exposing the recurrent laryngeal nerve and parathyroid is an effective method to prevent major complica-tions. Invasion of recurrent laryngeal nerve by thyroid cancer might not lead to hoarseness.
Objective To explore complications of endoscopic thyroidectomy and conventional thyroidectomy and to analyze causes of them in order to reducing complications of endoscopic thyroidectomy. Methods A total of 1 112 patients with thyroid diseases from September 2008 to March 2017 in the Shanghai Tongren Hospital were collected, then were designed to endoscopic thyroidectomy group and conventional thyroidectomy group. The recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, tracheoesophageal injury, poor healing of surgical wound, skin ecchymosis and subcutaneous effusion, neck discomfort, and CO2 related complications were observed. Results ① There were 582 cases in the endoscopic thyroidectomy group and 530 cases in the conventional thyroidectomy group, the baselines such as the gender, age, most diameter of tumor, diseases type, operative mode, operative time, and intraoperative bleeding had no significant differences between the endoscopic thyroidectomy group and the conventional thyroidectomy group (P>0.05). ② All the operations were performed successfully, none of patients was converted to the open operation. The rates of the recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, and tracheoesophageal injury had no significant differences in these two groups (P>0.05). The rates of the poor healing of surgical wound and neck discomfort were significantly lower and the rate of the skin ecchymosis and subcutaneous effusion was significantly higher in the endoscopic thyroidectomy group as compared with the conventional thyroidectomy group (P<0.05). There were 32 cases of CO2 related complications in the endoscopic thyroidectomy group. Conclusion Results of this study show that endoscopic thyroidectomy is safe for thyroid diseases, it’s complications could be reduced by improving operation technique.
ObjectiveTo systematically evaluate the reliability and stability of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and conventional open thyroidectomy (COT) in the treatment of differentiated thyroid cancer.MethodsThe clinical studies of TOETVA and COT in the treatment of differentiated thyroid cancer were retrieved from major databases including PubMed, Embase, Cochrane Library, Wanfang, and CNKI by computer. The search date ended on March 1, 2020. Two investigators screened the literatures strictly and extracted the data following the pre-defined inclusion and exclusion criteria, and then used RevMan 5.3 software for meta-analysis.ResultsA total of 7 studies including 1 465 patients were included in this meta-analysis. The results showed: compared with the COT group, the operation time of the TOETVA group was longer [WMD=35.18, P=0.000 1], and the number of lymph node dissections in the central area was larger [WMD=1.42, P=0.000 5]. But the intraoperative blood loss [WMD=–5.32, P=0.39], the length of hospital stay after operation [WMD=0.05, P=0.94], the incidences of transient recurrent laryngeal nerve palsy [OR=0.81, P=0.43], transient hypocalcemia [OR=0.55, P=0.35], permanent hypocalcemia [OR=0.39, P=0.22], permanent recurrent laryngeal nerve palsy [OR=1.34, P=0.73], and hematoma [OR=1.29, P=0.69] were not statistically significant between the two groups.ConclusionsTOETVA has a higher stability. Although the COT has a shorter operation time, the former has a higher central lymph node dissection rate, and there is no scar on the neck after surgery and no significant difference in the incidence of postoperative complications.
ObjectiveTo compare the clinical efficacy of endoscopic thyroidectomy via breast approach and open thyroidectomy for multiple nodular goiter. MethodsBetween September 2010 and March 2013, a total of 138 patients with multiple nodular goiter were divided into two groups based on even or odd number. Patients in the endoscopy group (n=69) had a mean age of 38.3 years and they underwent endoscopic thyroidectomy via breast approach, while patients in the open group (n=69) had a mean age of 36.8 years and underwent open thyroidectomy. Surgery time, blood loss, pain and drainage, as well as postoperative complications were compared between these two groups. ResultsSurgery time in the endoscopy group was significantly longer than that in the open group (P<0.05). Blood loss in the endoscopy group was significantly less than that in the open group (P<0.05). Scores of pain at different times in the endoscopy group were significantly lower than those in the open group (P<0.05). There was no significant difference in drainage and duration of drainage between the two groups (P>0.05). There were no significant differences in incidence of transient hypocalcemia, hypoparathyroidism and recurrent laryngeal nerve injury between the two groups (P>0.05). ConclusionEndoscopic thyroidectomy via breast approach and open thyroidectomy are both effective and safe procedures for multiple nodular goiter. However, endoscopic thyroidectomy via breast approach is superior to open thyroidectomy in reducing blood loss, relieving pain with excellent cosmetic results.