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甲状腺手术并发症管理的叙述性综述

Narrative review of management of thyroid surgery complications.

作者信息

Jin Shan, Sugitani Iwao

机构信息

Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.

Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.

出版信息

Gland Surg. 2021 Mar;10(3):1135-1146. doi: 10.21037/gs-20-859.

Abstract

Currently, thyroid surgery is the most common and safe operation worldwide. However, thyroidectomy is still not free from the risks of complications and death due to the anatomical structure and physiological function particularity of the thyroid gland. Postoperative complications affect the life quality and life safety of patients after surgery. The common complications include hypoparathyroidism (HP), recurrent laryngeal nerve (RLN) injury, injury to the external branch of the superior laryngeal nerve (EBSLN), postoperative bleeding (PB), thoracic duct injury, laryngeal edema, tracheospasm, tracheal injury, and esophageal injury. A severe complication, such as dyspnea, asphyxia, or thyroid crisis, might cause the death of the patient. Therefore, every thyroid surgeon's responsibility is to remain alert and aware of the occurrence of various intraoperative and postoperative complications and exercise effective prevention and treatment. This is closely related to the advancement in thyroid disease research, the increase in local anatomy knowledge, the standardization of surgical approaches, the improvement in operating skills, the application of new technologies, and the emphasis on specialty training. In addition, many complications that effect patients are much better tolerated if the patient has appropriate expectations of what the complications are and how to treat them. Open communication between surgeon and patient optimizes the potential negative effects that complications may have on patients' quality of life. This paper discusses the prevention, recognition and therapy of intraoperative and postoperative complications in thyroid surgery.

摘要

目前,甲状腺手术是全球最常见且安全的手术。然而,由于甲状腺的解剖结构和生理功能特殊性,甲状腺切除术仍无法完全避免并发症和死亡风险。术后并发症会影响患者术后的生活质量和生命安全。常见并发症包括甲状旁腺功能减退(HP)、喉返神经(RLN)损伤、喉上神经外支(EBSLN)损伤、术后出血(PB)、胸导管损伤、喉水肿、气管痉挛、气管损伤和食管损伤。严重并发症,如呼吸困难、窒息或甲状腺危象,可能导致患者死亡。因此,每位甲状腺外科医生的职责是时刻警惕并了解各种术中及术后并发症的发生情况,并进行有效的预防和治疗。这与甲状腺疾病研究的进展、局部解剖知识的增加、手术方法的标准化、手术技巧的提高、新技术的应用以及对专科培训的重视密切相关。此外,如果患者对并发症及其治疗方法有适当的预期,那么许多影响患者的并发症的耐受性会好得多。外科医生与患者之间的开放沟通可优化并发症可能对患者生活质量产生的潜在负面影响。本文讨论了甲状腺手术中及术后并发症的预防、识别和治疗。

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