Thyroid surgery in children and adolescents
Thyroid surgery in children and adolescents
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DOI：
10.1016/j.ijporl.2004.04.024
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发表时间：
2004-10-01
影响因子：
1.5
通讯作者：
Betka, J
中科院分区：
文献类型：
--
作者：
Astl, J;Dvoráková, M;Betka, J
作者介绍了1991-2000年因甲状腺疾病在布拉格查尔斯大学第一医学院耳鼻咽喉科和头颈外科、布拉格IPVZ耳鼻咽喉科接受手术的3865例儿童和青少年患者中的114例。该组中的雄性/雌性比例为1：6.5，16（13.9%）为雄性，99（86.1%）为雌性。对于非恶性疾病，雄性/雌性比例为1：6.5，对于恶性疾病，为1：5.4。82例（71.9%）病例的甲状腺手术适用于非恶性疾病，其中11例为男性，71例为女性。最常见的原因是Graves-Basedow和Hashimoto中毒-39名儿童（34.2%），5名儿童（4.4%）为毒性腺瘤。13例（11.4%）因多发结节性甲状腺肿需手术治疗，22例（19.3%）因单发结节性甲状腺肿需手术治疗。3例（2.6%）因桥本甲状腺炎建议手术，1例（0.9%）因弥漫性甲状腺肿机械综合征建议手术。恶性肿瘤32例（28.1%），其中男5例，女27例。最常见的组织学类型是乳头状癌-25例（21.9%）。滤泡癌4例（3.5%），髓样癌3例（2.6%）。表1总结了儿童和成人的TNM分类。手术进行了两个孩子与远处转移（肺定位）。在这两个孩子的疾病前阶段持续超过12个月。该病的第一个表现是在颈部发现肿大和可触及的结节。作者总结了儿童和青少年甲状腺疾病的手术指征。甲状腺的治疗需要团队合作。手术指征由儿科内分泌学家与甲状腺外科专业外科医生合作进行。通过手术显微镜识别喉返神经的可能性是一个毫无疑问的进步。儿童和成人应集中到卫生保健中心，不仅能够进行外科手术，而且还能够进行内分泌治疗。在患有恶性疾病的儿童中，需要与儿科肿瘤学家合作，并在核医学部门进行后续肿瘤治疗。作者总结了当今儿童和青少年甲状腺手术护理可能性的信息。他们指出了儿童和青少年手术适应症和手术范围的差异。(C)2004爱思唯尔爱尔兰有限公司保留所有权利。
Authors present 114 children and adolescents of the total 3865 patients that underwent surgery on the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Prague, Department of Otorhinolaryngology of IPVZ, Prague because of a thyroid disease in years 1991-2000. The male/female ratio in the group was 1:6.5, 16 (13.9%) mates and 99 (86.1%) females. For non-malignant disease, the mate/female ratio was 1:6.5 and for malignant disease, it was 1:5.4. Thyroid surgery was indicated for non-malignant disease in 82 (71.9%) cases - 11 mates and 71 females. Most frequently it was indicated because of Graves-Basedow and Hashimoto toxicosis - in 39 children (34.2%), in 5 children (4.4%) for toxic adenoma. Because of the polynodular goiter surgery was indicated in 13 cases (11.4%), in 22 cases (19.3%) for mononodular goiter. Three girls (2.6%) were recommended for surgery because of Hashimoto thyreoiditis and for mechanic syndrome in diffuse goiter one girt (0.9%). Malignant tumor was found in 32 children (28.1%) - 5 mates and 27 females. Most frequent histological type was papillary cancer - in 25 cases (21.9%). Follicular cancer was diagnosed in four cases (3.5%) and medullar cancer in three cases (2.6%). TNM classification in children and adults is summarized in Table 1. Surgery was carried out in two children with distant metastases (lung localization). In both children the pre-disease stage lasted more than 12 months. The first manifestation of the disease was a finding of enlarged and palpable nodes on the neck. The authors summarize indications for surgery of thyroid diseases in children and adolescents. A treatment of the thyroid gland is a teamwork. Indication for surgery is carried out by a pediatric endocrinologist in cooperation with a surgeon specialized in thyroid surgery. The possible identification of the recurrent laryngeal nerve by a surgery microscope is an unquestionable advance. Children and adults should be centralized into health-care centers capable not only of surgery, but also of endocrinology care. In children with a malignant disease there is a need for cooperation with a pediatric oncologist and a following oncological treatment on a nuclear medicine department. The authors summarize the information about today's thyroid surgery care possibilities for children and adolescents. They point out the differences in indications and the decision about extent of surgery in children and adolescents. (C) 2004 Elsevier Ireland Ltd. All rights reserved.