The Identification of Intraoperative Risk Factors Can Reduce, but Not Exclude, the Need for Completion Thyroidectomy in Low-Risk Papillary Thyroid Cancer Patients.
术中危险因素的识别可以减少但不排除低风险甲状腺乳头状癌患者完成甲状腺切除术的需要。
completion thyroidectomy low-risk papillary thyroid cancer risk factors
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摘要

                        Background:
                     The extent of initial surgical resection for low-risk papillary thyroid cancer (PTC) remains debatable. Since the 2015 American Thyroid Association (ATA) guidelines, several retrospective studies have reported that 40-60% of patients initially treated with lobectomy would require a completion thyroidectomy (CTx) due to high-risk pathological features (HRFs). These studies are limited by variable preoperative stratification and inability to quantify the value of intraoperative assessment. The study objectives were to determine whether diligent preoperative and intraoperative assessment improves the appropriateness of initial surgery for low-risk PTCs and whether varying the criteria for lobectomy reduces the need for CTx. 
                        Methods:
                     A prospectively collected province-wide database was analyzed over a 10-year period (2008-2017) for patients who underwent a total thyroidectomy (TT) for PTC without preoperative HRFs. All patients had preoperative ultrasound and fine-needle aspirates. Unique to this database are mandatory synoptic operative fields that identify intraoperative risk factors such as positive lymph nodes and local invasion. 
                        Results:
                     In total, 74% of patients (709/959) were deemed eligible for lobectomy. Of those eligible, 149 (21%) had intraoperative risk factors that would necessitate conversion to TT at the initial operation. A further 209 (30%) would require CTx due to HRFs on final pathology. Varying the preoperative criteria for lobectomy did not significantly affect intraoperative conversion or CTx rates. 
                        Conclusions:
                     Although intraoperative assessment reduced the need for CTx in 21%, up to 30% of patients would still require a second operation. Altering the preoperative criteria does not influence this outcome. Patients deemed eligible for lobectomy should be informed that despite careful pre- and intraoperative assessment, there is up to a 30% risk of requiring CTx.

译文

背景:
低风险甲状腺乳头状癌 (PTC) 的初始手术切除程度仍有争议。自 2015 美国甲状腺协会 (ATA) 指南以来,几项回顾性研究报告称,最初接受肺叶切除术的患者中有 40-60% 需要完成甲状腺切除术 (CTx) 由于高危病理特征 (HRFs)。这些研究受限于可变的术前分层和无法量化术中评估的价值。研究的目的是确定勤奋的术前和术中评估是否提高了低风险 PTCs 的初始手术的适当性,以及改变肺叶切除术的标准是否减少了对 CTx 的需求。
方法:
在 10 年的时间内 (2008-2017) 分析了一个前瞻性收集的全省范围的数据库,该数据库针对在没有术前 HRFs 的情况下接受 PTC 甲状腺全切除术 (TT) 的患者。所有患者术前均有超声检查和细针抽吸。该数据库独有的是识别术中危险因素如阳性淋巴结和局部侵犯的强制性概要手术区域。
结果:
总的来说,74% 的患者 (709/959) 被认为有资格接受肺叶切除术。在那些合格的人中,149 (21%) 有术中风险因素,需要在初次手术时转换为 TT。由于最终病理的 HRFs,另外 209 (30%) 需要 CTx。改变肺叶切除术的术前标准不会显著影响术中转化率或 CTx 率。
结论:
尽管术中评估减少了 21% 对 CTx 的需求,但高达 30% 的患者仍需要第二次手术。改变术前标准不会影响这一结果。被认为有资格接受肺叶切除术的患者应该被告知,尽管进行了仔细的术前和术中评估,但需要 CTx 的风险高达 30%。

Thyroidectomy

内分泌 手术 治疗方法
概述  :  

甲状腺切除术是涉及外科手术切除全部或部分甲状腺的手术。当患者患有甲状腺癌或甲状腺的某些其他疾病(例如甲状腺功能亢进)或甲状腺肿大时,内分泌或头颈外科医生通常会建议进行甲状腺切除术。其他手术适应症包括美容(甲状腺肿大)或症状性阻塞(导致吞咽或呼吸困难)。 手术类型 ①甲状腺切除术:切除整个峡部和1个叶,适用于仅做过1个叶的良性疾病。 ②甲状腺大部切除术:去除大部分两叶,在一侧或两侧留下4-5克(相当于正常甲状腺的大小)的甲状

thyroidectomy   英 /,θaɪrɒɪ'dektəmɪ/   美 /,θaɪrɔɪ'dɛktəmi/

释    义   n. [外科] 甲状腺切除术

例    句   Objective To explore diagnosis and countermeasure of tracheomalacia in thyroidectomy.目的探讨甲状腺切除术中气管软化的诊断及对策。

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