Application of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type <b>Ⅰ</b> substernal goiter _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Youlin ,  HU Chaohua ,  SHEN Xiongshan , HAN Yuntao , LI Weimin , SHEN Haoyuan , PENG Dongjie , XU Yuanbing

Department of General Surgery, Affiliated Xiaogan Hospital of Wuhan University of Science and Technology, Xiaogan Central Hospital, Diagnosis and Treatment Center of Thyroid and Breast Disease of Xiaogan, Xiaogan, Hubei 432000, P. R. China;

Corresponding author：

HU Chaohua, Email: huchaohua2006@126.com; SHEN Xiongshan, Email: shenxs@medmail.com.cn

Keywords：

thyroidectomy; recurrent laryngeal nerve; superior laryngeal nerve; parathyroid gland; type Ⅰ substernal goiter; ultrasonic scalpel; bipolar coagulation forcep

DOI：

10.7507/1007-9424.201708002

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.

Citation： YU Youlin, HU Chaohua, SHEN Xiongshan, HAN Yuntao, LI Weimin, SHEN Haoyuan, PENG Dongjie, XU Yuanbing. Application of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(2): 184-190. doi: 10.7507/1007-9424.201708002 Copy

1.	赵敬柱, 于洋, 李亦工, 等. 胸骨后甲状腺肿瘤的外科治疗. 中国肿瘤临床, 2013, 40(13): 796-798.
2.	吴跃煌, 祁永发, 唐平章, 等. 胸骨后甲状腺肿的手术径路. 中华耳鼻咽喉头颈外科杂志, 2006, 41(7): 528-531.
3.	Hajhosseini B, Montazeri V, Hajhosseini L, et al. Mediastinal goiter: a comprehensive study of 60 consecutive cases with special emphasis on identifying predictors of malignancy and sternotomy. Am J Surg, 2012, 203(4): 442-447.
4.	蒋波, 彭瑶, 王浩, 等. 颈部入路切除胸骨后甲状腺肿57例临床分析. 中国普通外科杂志, 2017, 26(3): 347-357.
5.	Barbetakis N, Asteriou C, Paliouras D, et al. eComment. Substernal goiter. Beware of the thyroidea ima artery. Interact Cardiovasc Thorac Surg, 2014, 19(1): 143.
6.	Kilic D, Findikcioglu A, Ekici Y, et al. When is transthoracic approach indicated in retrosternal goiters? Ann Thorac Cardiovasc Surg, 2011, 17(3): 250-253.
7.	Qureishi A, Garas G, Tolley N, et al. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg, 2013, 11(3): 203-208.
8.	McKenzie GA, Rook W. Is it possible to predict the need for sternotomy in patients undergoing thyroidectomy with retrosternal extension? Interact Cardiovasc Thorac Surg, 2014, 19(1): 139-143.
9.	Sudarshan Babu KG, Shantharam L. A study of complications of thyroidectomy. Int J Cur Res Rev, 2013, 5(17): 95-101.
10.	U P S, K B P, Karanam L. Preoperative preparation with Lugol's iodine in thyroidectomy of euthyroid patients—Is it really mandatory? —An Otorhinolaryngologist's View. J Clin Diagn Res, 2014, 8(8): KC01-KC02.
11.	Rudolph N, Dominguez C, Beaulieu A, et al. The morbidity of reoperative surgery for recurrent benign nodular goitre: impact of previous unilateral thyroid lobectomy versus subtotal thyroidectomy. J Thyroid Res, 2014, 2014: 231857.
12.	Joliat GR, Guarnero V, Demartines N, et al. Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Incidence and postoperative evolution assessment. Medicine (Baltimore), 2017, 96(17): e6674.
13.	Hayward NJ, Grodski S, Yeung M, et al. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg, 2013, 83(1-2): 15-21.
14.	Enomoto K, Uchino S, Watanabe S, et al. Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factors and outcome analysis. Surgery, 2014, 155(3): 522-528.
15.	Shi C, Tian B, Li S, et al. Enhanced identification and functional protective role of carbon nanoparticles on parathyroid in thyroid cancer surgery: A retrospective Chinese population study. Medicine (Baltimore), 2016, 95(46): e5148.
16.	龚单春, 张海东, 刘亚群, 等. 甲状腺腺叶切除术精细化操作技术临床结果初步报告. 中华耳鼻咽喉头颈外科杂志, 2015, 50(1): 28-32.
17.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
18.	王朝晖, 蔡永聪, 陈锦, 等. 精细化被膜解剖法在甲状腺全切手术中的应用.中华普通外科学文献(电子版), 2014, 8(1): 8-11.
19.	Wu G, Wang K. A novel variation of the recurrent laryngeal nerve. BMC Surg, 2017, 17(1): 66.
20.	余幼林, 胡超华, 韩运涛, 等. 甲状腺手术中喉返神经解剖变异特征及显露方法的再认识. 中国普通外科杂志, 2017, 26(5): 660-665.
21.	Wang K, Cai H, Kong D, et al. The identification, preservation and classification of the external branch of the superior laryngeal nerve in thyroidectomy. World J Surg, 2017, 41(10): 1521-2529.
22.	Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
23.	王天笑, 于文斌, 马骁, 等. 甲状腺全切除术和近全切除术术后甲状旁腺功能损伤的危险因素分析. 中华外科杂志, 2016,54(3): 206-211.
24.	Sebastian M, Rudnicki J, Jakubaszko W, et al. Clinical and biochemical factors affecting postoperative hypocalcemia after near-total thyroidectomy. Adv Clin Exp Med, 2013, 22(5): 675-682.
25.	Antakia R, Edafe O, Uttley L, et al. Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis. Thyroid, 2014, 25(1): 1-12.
26.	张浩, 张挺.甲状腺手术中能量器械对甲状旁腺的保护与损伤. 中国普外基础与临床杂志, 2017, 24(10): 1183-1185.

1. 赵敬柱, 于洋, 李亦工, 等. 胸骨后甲状腺肿瘤的外科治疗. 中国肿瘤临床, 2013, 40(13): 796-798.
2. 吴跃煌, 祁永发, 唐平章, 等. 胸骨后甲状腺肿的手术径路. 中华耳鼻咽喉头颈外科杂志, 2006, 41(7): 528-531.
3. Hajhosseini B, Montazeri V, Hajhosseini L, et al. Mediastinal goiter: a comprehensive study of 60 consecutive cases with special emphasis on identifying predictors of malignancy and sternotomy. Am J Surg, 2012, 203(4): 442-447.
4. 蒋波, 彭瑶, 王浩, 等. 颈部入路切除胸骨后甲状腺肿57例临床分析. 中国普通外科杂志, 2017, 26(3): 347-357.
5. Barbetakis N, Asteriou C, Paliouras D, et al. eComment. Substernal goiter. Beware of the thyroidea ima artery. Interact Cardiovasc Thorac Surg, 2014, 19(1): 143.
6. Kilic D, Findikcioglu A, Ekici Y, et al. When is transthoracic approach indicated in retrosternal goiters? Ann Thorac Cardiovasc Surg, 2011, 17(3): 250-253.
7. Qureishi A, Garas G, Tolley N, et al. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg, 2013, 11(3): 203-208.
8. McKenzie GA, Rook W. Is it possible to predict the need for sternotomy in patients undergoing thyroidectomy with retrosternal extension? Interact Cardiovasc Thorac Surg, 2014, 19(1): 139-143.
9. Sudarshan Babu KG, Shantharam L. A study of complications of thyroidectomy. Int J Cur Res Rev, 2013, 5(17): 95-101.
10. U P S, K B P, Karanam L. Preoperative preparation with Lugol's iodine in thyroidectomy of euthyroid patients—Is it really mandatory? —An Otorhinolaryngologist's View. J Clin Diagn Res, 2014, 8(8): KC01-KC02.
11. Rudolph N, Dominguez C, Beaulieu A, et al. The morbidity of reoperative surgery for recurrent benign nodular goitre: impact of previous unilateral thyroid lobectomy versus subtotal thyroidectomy. J Thyroid Res, 2014, 2014: 231857.
12. Joliat GR, Guarnero V, Demartines N, et al. Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Incidence and postoperative evolution assessment. Medicine (Baltimore), 2017, 96(17): e6674.
13. Hayward NJ, Grodski S, Yeung M, et al. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg, 2013, 83(1-2): 15-21.
14. Enomoto K, Uchino S, Watanabe S, et al. Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factors and outcome analysis. Surgery, 2014, 155(3): 522-528.
15. Shi C, Tian B, Li S, et al. Enhanced identification and functional protective role of carbon nanoparticles on parathyroid in thyroid cancer surgery: A retrospective Chinese population study. Medicine (Baltimore), 2016, 95(46): e5148.
16. 龚单春, 张海东, 刘亚群, 等. 甲状腺腺叶切除术精细化操作技术临床结果初步报告. 中华耳鼻咽喉头颈外科杂志, 2015, 50(1): 28-32.
17. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
18. 王朝晖, 蔡永聪, 陈锦, 等. 精细化被膜解剖法在甲状腺全切手术中的应用.中华普通外科学文献(电子版), 2014, 8(1): 8-11.
19. Wu G, Wang K. A novel variation of the recurrent laryngeal nerve. BMC Surg, 2017, 17(1): 66.
20. 余幼林, 胡超华, 韩运涛, 等. 甲状腺手术中喉返神经解剖变异特征及显露方法的再认识. 中国普通外科杂志, 2017, 26(5): 660-665.
21. Wang K, Cai H, Kong D, et al. The identification, preservation and classification of the external branch of the superior laryngeal nerve in thyroidectomy. World J Surg, 2017, 41(10): 1521-2529.
22. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
23. 王天笑, 于文斌, 马骁, 等. 甲状腺全切除术和近全切除术术后甲状旁腺功能损伤的危险因素分析. 中华外科杂志, 2016,54(3): 206-211.
24. Sebastian M, Rudnicki J, Jakubaszko W, et al. Clinical and biochemical factors affecting postoperative hypocalcemia after near-total thyroidectomy. Adv Clin Exp Med, 2013, 22(5): 675-682.
25. Antakia R, Edafe O, Uttley L, et al. Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis. Thyroid, 2014, 25(1): 1-12.
26. 张浩, 张挺.甲状腺手术中能量器械对甲状旁腺的保护与损伤. 中国普外基础与临床杂志, 2017, 24(10): 1183-1185.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content