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SUMMARY INTRODUCTION: Obesity is a growing public health problem associated with many comorbid diseases. The aim of this study was to evaluate the relationship between body mass index and complications of thyroidectomy. METHODS: Patients who underwent total thyroidectomy between January 2015 and December 2018 were enrolled. Patients were divided into two groups, i.e., BMI <25 (group A) and BMI≥ 25 (group B). Demographics, operative time, and complications were retrospectively reviewed. RESULTS: The study included 145 patients (66 in Group A and 79 in Group B). There was no significant difference between the two groups in terms of age (p=0.330) and gender (p=0.055). No surgical site infection and bleeding complications were observed in any patients. The mean operative time was 148.4 minutes (90-235) in Group A and 153.4 minutes (85-285) in Group B (p=0.399). Transient hypocalcemia was observed in 25 (37.9%) patients in group A, and 23 (29.1%) patients in Group B (p = 0.291). Permanent hypocalcemia was not observed in any patient in group A, and in 2 patients in Group B (2.5%) (p = 0.501). Transient recurrent nerve palsy was observed in 1 (1.5%) patient in Group A and in 3 (3.8%) patients in Group B (p=0.626). None of the patients had permanent recurrent nerve palsy. Parathyroid autotransplantation was performed on 1 patient (1.5%) in group A and on 7 (8.9%) patients in Group B (p=0.055). CONCLUSION: We think there is no relationship between a high BMI and thyroidectomy complications, and surgery can also be performed safely in this patient group.
RESUMO INTRODUÇÃO: A obesidade é um crescente problema de saúde pública associado a muitas doenças comórbidas. O objetivo deste estudo foi avaliar a relação entre o índice de massa corporal e as complicações da tireoidectomia. MÉTODOS: Os pacientes submetidos a tireoidectomia total entre janeiro de 2015 e dezembro de 2018 foram incluidos. Os pacientes foram divididos em dois como IMC <25 (grupo A) e IMC . 25 (grupo B). Demografia, tempo operatorio e complicacoes revisadas retrospectivamente. RESULTADOS: O estudo incluiu 145 pacientes (66 no grupo A e 79 no grupo B). Não houve diferença significativa entre os dois grupos em termos de idade (p = 0,033) e sexo (p = 0,055). Nenhuma infecção do sítio cirúrgico e complicações hemorrágicas foram observadas em nenhum paciente. O tempo operatório médio foi de 148,4 minutos (90-235) no grupo A e 153,4 minutos (85-285) no grupo B (p = 0,399). Hipocalcemia transitória foi observada em 25 (37,9%) pacientes do grupo A e 23 (29,1%) do grupo B (p = 0,291). Hipocalcemia permanente não foi observada em nenhum paciente do grupo A e em 2 pacientes do grupo B (2,5%) (p = 0,501). Paralisia nervosa recorrente transitória foi observada em 1 (1,5%) paciente no grupo A e em 3 (3,8%) pacientes no grupo B (p = 0,626). Nenhum dos pacientes apresentou paralisia nervosa recorrente permanente. O autotransplante de paratireóide foi realizado em 1 paciente (1,5%) no grupo A e em 7 (8,9%) pacientes no grupo B (p = 0,055). CONCLUSÃO:: Acreditamos que não há relação entre um IMC alto e as complicações da tireoidectomia e a cirurgia pode ser realizada com segurança também neste grupo de pacientes.
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Humans , Male , Female , Thyroidectomy/adverse effects , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Body Mass Index , Retrospective Studies , Operative Time , Hypocalcemia/etiologyABSTRACT
Objective To explore the value of monitoring techniques of the external branch of superior laryngeal nerve (EBSLN) in thyroid surgery and to study its protective effects on vocal function after thyroid surgery.Methods We retrospectively analyzed the clinical data of 139 patients who underwent primary surgery of papillary thyroid cancer with neurological monitoring from Jun.2017 to Mar.2018 in the General Surgery Department of PLA General Hospital.The tumors of 31 cases were located in the upper pole of the gland and elsewhere in 108 cases.The patients' vocal function was assessed at one week and one month after surgery.The rate of EBSLN identified visually and by the intraoperative nerve monitoring (IONM) were counted.EBSLN recognition efficiency and prevalence of EBSLN damage during the operation of tumor in upper pole of thyroid and in other location were compared.Results In the 139 patients,there were 218 upper poles(218 EBSLN) treated intraoperatively,of which 145 were recognized visually (126(57.8％) confirmed by IONM,and 203(93.1％) were identified by IONM,OR=8.27(x2=59.345,P=0.00).The percentage of EBLSN located in the upper pole accurately identified by the naked eye was 20/46(43.5％) while by IONM was 43/46(93.4％).The percentage of EBSLN at the other position accurately identified visually was 106/172(61.6％),and by IONM was 160/172(93.0％).The number of visually identified cases in different locations showed significantly differences according to the chi-square test (x2=4.901,P=0.027),and no significant difference by IONM identification according to chi-square test (x2=0.012,P=0.914).Five patients had a low voice at one week postoperatively and low voice and vocalization change were not observed after one month.Conclusions IONM can effectively increase the proportion of intraoperative EBSLN identification to ensure the safety of surgery.The difficulty of visual identification of EBSLN during the surgery of tumor in upper pole is greater than that in other locations.IONM can provide more evidences for nerve protection and reduce the risk of injury.
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Laryngeal nerves injury,including recurrent laryngeal nerve (RLN) and superior laryngeal nerve,is one of the most terrible complications of thyroid surgery.External branch of superior laryngeal nerve (EBSLN) is adjacent to the upper pole of thyroid gland,which make it vulnerable to be injured during the ligation of the superior thyroid vessels.As a result,patients would have phonating dysfunction,especially the changes in the voice quality alongside the alterations in the high pitched sound production ability.Intraoperative neural monitoring technique applying neural electrophysiology method to detect and protect the nerve and assess its function during the operation decreases the occurrence of EBSLN injury and improves the living quality.This article is going to make a review of the progress of the application.
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Objective:To investigate the optimal time of tracheotomy/arytenoidectomy and the improvement of dyspnoea, dysphonia and dysphagia after arytenoidectomy with CO₂ laser in iatrogenic bilateral vocal folds paralysis patients. Method:Thirty patients [29 females, 56 (49-60) years, one male, 49 years] with bilateral vocal cords paralysis resulted from neck surgery were retrospectively analyzed by case archived information and following-up questionnaire. The data included patients' dysponea time, degree and duration from tracheotomy/arytenoidectomy to neck surgery. Twenty sixty patients required unilateral partial/total arytenoidectomy. The results of treatment were evaluated by questionnaire including dyspnoea, dysphonia and dysphagia. Result:All patients whose bilateral vocal paralysis were resulted from thyroid gland surgery. Dysponea occurred immediately after thyroidectomy surgery in 14 cases (46.7%), and 2 years later after thyroidectomy in 13 cases (43.3%), 8 years later in 3 cases (10.0%). There was one (3.3%) patient without tracheotomy. The duration of tracheotomy/arytenoidectomy to neck surgery was significantly correlated with duration of tracheotomy/arytenoidectomy to dyspnoea appearance (r=0.879, P<0.05), not correlated with duration of thyroid surgery to dyspnoea appearance. There is significantly negative correlation between degree of dyspnoea and duration of tracheotomy/arytenoidectomy to neck surgery (r=0.452, P<0.05). Twenty six patients appeared dyspnoea and underwent CO₂ laser arytenoidectomy after thyoidectomy 0.5-23 years. Five patients did unilateral total arytenoidectomy and 21 patients did unilateral partial arytenoidectomy. After 12-96 months following up, dyspnoea improved in 24 patients, no improved in 2 patients. Dysphonia improved and remained in 17 patients, being worse mildly in 8 patients and obviously in one patient. Dysphagia improved and remained in 24 patients, being worse in 2 patients. There was no difference between total and partial arytenoidectomy in dyspnoea, dysphonia and dysphagia. Conclusion:The morbidity of dyspnoea was correlated with time after neck surgery. It was rarely necessary to take tracheotomy immediately in bilateral vocal fords paralysis patients after neck surgery. The severer degree of dyspnoea led to shorter duration between neck surgery and tracheotomy/arytenoidectomy. There was obvious improvement after arytenoidectomy in dyspnoea, no significant change in dysphonia and dysphagia. The effect of total arytenoidectomy on bilateral vocal paralysis was similar to partial arytenoidectomy.
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ObjectiveTo explore the efficacy of sevoflurane or propofol combined with remifentanil during the maintenance of general anesthesia in thyroid gland surgery.MethodsSixty patients underwent thyroid gland surgery were randomly divided into tow groups.Once the larynx mask was intubated, anesthesia was maintained with propofol(the effect site concentration was 2.5 ～3.5mg/L) and remifentanil(the effect site concentration was 4.5 ～5.5μg/L) by TCI technique in group P,but with sevoflurane(2％～4％) and remfentanil(the effect site concentration was 2.5 ～4.0g/L)in group S.The depth of anesthesia was measured by the A-line TM AEP Monitor which expressed as A-Line ARX Index TM(AAI).All patients' SBP,DBP and HR were recorded at eight time points: before induction time(T0) ,after induction but before larynx mask intubation time(T1) ,intubate larynx mask time(T2) ,cut skin time (T3), separate thyroid gland time (T4), cut thyroid gland time (T5), remove larynx mask time (T6) ,leave the operation room time(T7).The emergency time,the conscious of the patients after anesthesia and the side effects were also recorded.ResultsThere were no significant differences between the groups with respect to age,gender,weight,the duration of operation,the emergency time and the conscious of the patients after anesthesia.SBP,DBP,HR of the patients in both groups showed no significant difference at T0,T1 ,T2, T3 (all P ＞ 0.05), but had significant difference at T4,T5,T6, T7 (all P ＜ 0.05).Compare with group P,the incidentce of restlessness, dizziness, drowsiness, rigor and pain was significantly lower in group S(all P ＜0.05).The incidentce of nausea,vomit and aspiration did not appear in both groups.ConclusionBoth groups showed good anesthesia effects and the patients also emerged from anesthesia quickly.But the anesthesia maintained with sevoflurane and remifentanil could bring more stable hemodynamics and lower incidence rate of the side effects.
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Objective To discuss the methods and significance of exposing recurrent laryngeal nerve in thyroidectomy.Methods 328 recurrent laryngeal nerve were dissected and exposed.In 216 procedures(3 nerve were not recurrent,and all were in right lateral.),150(45.73%)nerve were dissected by infra thymid gland route,178(54.27%)by lateral thyroid gland route.Results There was no permanent injury of recurrent laryngeal nerve.It took 5 minutes on average to reveal nerve by infra thyroid gland route and there were 5 cases (2.00%)of temporary recurrent laryngeal nerve injury.It took 3 minutes on average to reveal nerve by lateral thyroid gland route,and there were 2 cases(1.12%)of temporary recurrent laryngeal nerve injury.Conclusions It is safe and convenient to expose recurrent laryngeal nerve during operation.Lateral route has advantages of less time consuming,minimal injury and less bleeding.