Issue N# 3 - 2008
Post-operative complications and predictive factors in a series of 117 total thyroidectomies for substernal goiter
Authors : Ayache S, Mardyla N, Tramier B, Strunski V. (Amiens)
Ref. : Rev Laryngol Otol Rhinol. 2008;129,3:181-189.
Article published in french
Downloadable PDF document french
Objective: the recurrential nerve palsy (RNP), the hypocalcemy and bleeding are traditional complications of the thyroid surgery. The objective is to bring back the post-operative rates of complications and to compare them with the patientís history and the goiter features (CT-scan extensions and weight) in order to identify predictive factors of these complications. Patients and method: One hundred and seventeen patients with a goiter below the subclavicular vessels on the cervicothoracic CT-scan and with a benign extemporane histopathology were operated between february 1997 and January 2004 and included in this retrospective study. The initial clinical assessment reports the respiratory and digestive functional signs, researches a palpable mass and studies the mobility of the vocal folds. The post-operative complications rates (RNP, hypocalcemy and bleeding) are analyzed according to the patientís history and the goiter extensions in order to correlate these factors with the complications occurence. Results: Five unilateral RNP occurred and two of them remained permanent, particularly for patients with thyroid surgery history (NS). The right/left or anterior/posterior extensions did not seem determining factors. Nevertheless the volume of the goiter suspected by the tracheal latero-deviation seems to play a role but without statistical confirmation. Among the thirty-four hypocalcemies, six were defined like permanent, without correlations with the surgical history nor the systematic identification of parathyroid glands. The volume and the younger age of the patient tend nevertheless to support the hypocalcemy. Three post-operative bleeding cases were reported, which one needed a reoperation, with a correlation with thyroid surgical history. None the factors among volume, extension or the age of the patient seem to play a role. Conclusion: The cervico-thoracic CT-scan is essential since echography does not manage to identify the lower pole of the gland. It helps to define the goiter and to analyze its extensions, very usefull to predict surgical difficulties in the preoperative information of the patient. Complications occurrence seems related on the volume and the thyroid surgical history.
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