儿童甲状腺手术：单中心儿科经验

文献信息

中文摘要

背景： 儿童甲状腺疾病发病率的增加要求儿科外科医生接受适当的培训。该年龄组的特殊特征需要与成人不同的治疗方法。
方法： 作者报告了他们在5年期间的儿科经验。对于每位患者，我们分析了手术指征、手术类型、术后并发症和随访情况，平均随访时间为一年。
结果： 接受治疗的25例患者平均年龄为12岁（范围5-16岁），男女比例为1:1.27。最常见的临床表现是无症状颈部肿块或偶然发现的甲状腺结节，常在因体重减轻评估或其他疾病随访时发现。所有甲状腺结节患者均接受了术前细针穿刺，在恶性病例中指示手术。4例患者被诊断为Graves病。手术治疗由儿科外科医生和普外科医生进行。所有患者均接受了全甲状腺切除术，其中3例接受了淋巴结清扫。平均手术时间为80.7分钟（范围61.0-100.4分钟）。手术标本的组织病理学检查显示22例癌（18例乳头状癌和4例滤泡状癌）和3例自身免疫性甲状腺疾病。平均住院时间为4天（范围3-6天）。7例患者（28%）观察到短暂的无症状性低钙血症。术前喉镜检查发现2例患者（8%）存在单侧声带麻痹；这些异常在手术前已存在，因此不被视为手术并发症。3例患者接受了术后放射性碘治疗。儿科内分泌科医生进行了术后随访，包括临床评估、超声和实验室检查。
结论： 儿童甲状腺切除术应在专门的多学科儿科中心进行，并在适当情况下由经验丰富的甲状腺外科医生参与。

英文摘要

The increasing incidence of thyroid disease in children requires appropriate training for pediatric surgeons. The specific characteristics of this age group require a different treatment approach from that used in adults.The authors report their pediatric experience over a 5-year period. For each patient, we analyzed the indication for surgery, type of procedure, postoperative complications, and follow-up, with a mean follow-up of one year. The mean age of the 25 patients treated was 12 years (range, 5-16 years), and the male-to-female ratio was 1:1.27. The most common clinical presentation was asymptomatic neck swelling or an incidental finding of a thyroid nodule, often detected during evaluation for weight loss or follow-up for another condition. All patients with thyroid nodules underwent preoperative fine-needle aspiration, and surgery was indicated in cases of malignancy. Four patients were diagnosed with Graves' disease. Surgical treatment was performed by a pediatric surgeon and a general surgeon. All patients underwent total thyroidectomy, and three underwent lymph node dissection. The mean operative time was 80.7 min (range, 61.0-100.4 min). Histopathological examination of the surgical specimens showed 22 cases of carcinoma (18 papillary and 4 follicular) and 3 cases of autoimmune thyroid disease. The mean hospital stay was 4 days (range, 3-6 days). Transient asymptomatic hypocalcemia was observed in seven patients (28%). Preoperative laryngoscopy identified unilateral vocal cord paralysis in two patients (8%); these abnormalities were present before surgery and were therefore not considered surgical complications. Postoperative radioiodine treatment was administered to three patients. Pediatric endocrinologists conducted postoperative follow-up, including clinical assessment, ultrasound, and laboratory tests. Thyroidectomy in children should be performed in a specialized multidisciplinary pediatric center, with the involvement of an experienced thyroid surgeon when appropriate.