Article record

再次甲状腺切除术与首次甲状腺切除术的并发症特征：系统评价与荟萃分析

Complication Profile of Reoperative Thyroidectomy Versus First-Time Thyroidectomy: A Systematic Review and Meta-analysis.

综述 Meta咽喉科IF 2.1Q3

文献信息

PMID	42753362
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Ahmed Ghani 查看其他 11 位作者 Erasmus van Zoest；Al-Shifaa S Al Rashdi；Lamees M Al Darwashi；Aris Rafati；May Y Hajeir；Marios Alogakos；Karl Hage；Christian A Than；Hayato Nakanishi；Joyce Shin；Gustavo Romero-Velez
作者单位	School of Medicine, University College Dublin, Dublin, Ireland. 查看其他 7 条单位信息 School of Medicine, University of Nicosia, Nicosia, Cyprus.；School of Medicine, University of Bari Aldo Moro, Bari, Italy.；Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.；Department of Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, Ohio.；Cambridge University Hospitals NHS Foundation Trust, Cambridgeshire, UK; School of Biomedical Sciences, The University of Queensland, St Lucia, Australia.；Department of Surgery, Mayo Clinic, Rochester, Minnesota.；Department of Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio. Electronic address: romerog4@ccf.org.
期刊	The Journal of surgical research
SCI 分区	Q3
IF	2.1
研究类型	综述 Meta · 临床
所属专科	咽喉科

中文摘要

引言： 再次甲状腺切除术，定义为既往甲状腺切除术后因复发性甲状腺疾病而进行的手术，由于解剖结构扭曲和瘢痕形成，被广泛认为比首次甲状腺切除术具有更高的并发症可能性。尽管已认识到这些挑战，但现有证据异质性较大，缺乏全面的综合。因此，本荟萃分析旨在评估再次甲状腺切除术与首次甲状腺切除术之间的并发症发生率比较。
方法： 检索了PubMed、Ovid Embase、Cochrane Library、CINAHL、Scopus和Web of Science，从各自建库日期至2025年10月。该综述已在PROSPERO数据库前瞻性注册（CRD420251158243）。
结果： 共纳入23项研究，包含42,314例患者，其中4154例（9.8%）接受了再次甲状腺切除术。与首次甲状腺切除术相比，再次甲状腺切除术与一过性低钙血症（比值比[OR] = 1.53；95%置信区间[CI]：1.06-2.20；I2 = 84%）、永久性低钙血症（OR = 1.88；95% CI：1.33-2.67；I2 = 24%）、一过性喉返神经（RLN）损伤（OR = 2.57；95% CI：1.73-3.83；I2 = 72%）、永久性RLN损伤（OR = 3.94；95% CI：2.60-5.97；I2 = 47%）以及血肿（OR = 1.76；95% CI：1.12-2.78；I2 = 7%）的更高几率相关。
结论： 再次甲状腺切除术似乎比首次甲状腺切除术具有更高的并发症可能性，永久性RLN损伤的几率增加近4倍。这些发现强调了在考虑再次甲状腺切除术时，适当患者咨询、仔细患者选择和明确临床指征的重要性。

英文摘要

INTRODUCTION: Reoperative thyroidectomy, defined as surgery for recurrent thyroid disease following prior thyroid resection, is widely perceived to carry a greater likelihood of complications than first-time thyroidectomy due to anatomic distortion and scar formation. Despite recognition of these challenges, the existing evidence is heterogeneous and lacks comprehensive synthesis. Thus, this meta-analysis aims to evaluate the comparative complication rates between reoperative and first-time thyroidectomy.
METHODS: PubMed, Ovid Embase, Cochrane Library, CINAHL, Scopus, and Web of Science were searched from their respective inception dates to October 2025. The review was registered prospectively on the PROSPERO database (CRD420251158243).
RESULTS: Twenty-three studies comprising 42,314 patients were included, of whom 4154 (9.8%) underwent reoperative thyroidectomy. Reoperative thyroidectomy was associated with greater odds of transient hypocalcemia (odds ratio [OR] = 1.53; 95% confidence interval [CI]: 1.06-2.20; I2 = 84%), permanent hypocalcemia (OR = 1.88; 95% CI: 1.33-2.67; I2 = 24%), transient recurrent laryngeal nerve (RLN) injury (OR = 2.57; 95% CI: 1.73-3.83; I2 = 72%), permanent RLN injury (OR = 3.94; 95% CI: 2.60-5.97; I2 = 47%), and hematoma (OR = 1.76; 95% CI: 1.12-2.78; I2 = 7%) when compared with first-time thyroidectomy.
CONCLUSIONS: Reoperative thyroidectomy appears to carry a higher likelihood of complications than first-time thyroidectomy with an almost 4-fold increase in odds of permanent RLN injury. These findings emphasize the importance of appropriate patient counseling, careful patient selection, and clear clinical indications when considering reoperative thyroidectomy.