15年儿童甲状腺和甲状旁腺手术经验：临床结果与患者观点

文献信息

中文摘要

背景： 儿童甲状腺手术不常见。本研究评估了在已建立的综合儿童内分泌手术项目中，由高手术量成人甲状腺外科医生和儿童外科医生共同实施的甲状腺手术后，儿童/家长对并发症的感知。
方法： 一项回顾性队列研究分析了连续未选择患者的结果。使用标准化问卷收集患者报告的结果，包括嗓音障碍指数（VHI-10）、嗓音相关生活质量（VRQoL）、吞咽障碍评分和曼彻斯特瘢痕量表（MSS）。
结果： 2011年至2025年间，93名儿童接受了102次甲状腺或甲状旁腺手术。进行了全甲状腺切除术（n=53）和甲状腺叶切除术（n=27），平均术后住院1天。在20名甲状腺癌患儿中，12名因局部晚期疾病需要根治性颈清扫术，其中位住院时间为3天。暂时性（n=15）和永久性（n=1）甲状旁腺功能减退是最常见的记录并发症，但只有一名儿童需要补充钙超过12个月。一项邮寄调查收到了40名患者中32名（78%）的回复（27名女性），中位术后时间为40个月（范围5-111）。24名（75%）儿童的VHI-10评分正常，8名（25%）升高。24名（75%）的VRQoL极好。吞咽功能正常9名，轻度受影响21名，严重受影响2名。曼彻斯特瘢痕评分范围为5-16（中位数9），其中4名儿童评分为理想分5分。
结论： 在专科儿童和内分泌中心采用多学科方法进行时，儿童甲状腺手术是安全的，对嗓音的长期影响最小。

英文摘要

BACKGROUND: Thyroid surgery in children is uncommon. This study assessed children's/parents' perception of morbidity after thyroid surgery delivered within an established integrated paediatric endocrine surgery programme involving a high-volume adult thyroid surgeon and a paediatric surgeon.
METHODS: A retrospective cohort study analysed outcomes in consecutive unselected patients. Patient reported outcomes were collected using standardised questionnaires Voice Handicap Index (VHI-10), Voice-related Quality of Life (VRQoL), Swallowing Impairment Score and Manchester Scar Scale (MSS).
RESULTS: Between 2011-2025 93 children had 102 thyroid or parathyroid operations. Total thyroidectomy (n=53) and thyroid lobectomy (n=27) was performed with an average 1-day postoperative admission. Of the 20 children with thyroid cancer thyroid, 12 needed radical neck dissection for locally advanced disease and their median hospital stay was 3 days. Temporary (n=15) and permanent (n=1) hypoparathyroidism was the most common recorded complication but only one child needed calcium supplements for >12 months. A postal survey received replies from 32 of 40 patients (78%) patients (27 female) at a median of 40 months post-op (range 5-111). VHI-10 scores were normal in 24 (75%) children and increased in 8 (25%). VRQoL was excellent in 24 (75%). Swallowing was normal in nine, slightly affected in 21 and severely affected in two children. Manchester Scar Score ranged from 5-16 (median 9) with 4 children scoring the ideal score of 5.
CONCLUSION: When conducted with a multidisciplinary approach in a specialist paediatric and endocrine centre, paediatric thyroid surgery is safe and has minimal long-term impact on voice.