갑상선암의 내시경 갑상선 절제술에서 근전절제술 및 전절제술의 임상적 비교

유한모,김태원,배자성<SUP>1<,SUP>,조항주,김기환,안창혁,박우찬<SUP>2<,SUP>,이동호<SUP>3<,SUP>,김정수,Han Mo Yoo,M,D,Tae Won Kim,M,D,Ja Sung Bae,M,D,<SUP>1<,SUP>,Hang Joo Cho,M,D,Kee Hwan Kim,M,D,Chang Hyuk An,M,D,Woo Chan Park,M 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.4

Purpose: The aim of this study was to evaluate and compare the surgical outcomes of endoscopic total and near-total thyroidectomies in patients with thyroid cancer. Methods: Between February 2000 and January 2009, among 387 patients who underwent endoscopic thyroidectomy in our hospital, we evaluated 50 patients who underwent endoscopic total or near-total thyroidectomy. Thirty- five and 15 patients underwent endoscopic total thyroidectomy and near-total thyroidectomy, respectively. We analyzed the patients' clinicopathologic characteristics and post-operative complications between the two groups. Results: The mean size of tumors was 1.08 cm (range, 0.1∼3.5 cm) and the mean operative time was 192 minutes. Forty-nine tumors were papillary cancers and 1 tumor was a follicular cancer. Two patients in the endoscopic total thyroidectomy group underwent re-operation because of bleeding. In the near-total thyroidectomy group, one patient had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. In the total thyroidectomy group, nine patients had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. There was no statistical difference in the post-operative complicationrates between the two groups (P=0.254 for hypocalcemia and P=0.470 for injury to the recurrent laryngeal nerve). Conclusion: Based on our experience, endoscopic total thyroidectomy is a safe and feasible alternative to endoscopic near-total thyroidectomy. (Korean J Endocrine Surg 2009; 9:201-205)

갑상선 전 절제술 및 근전 절제술의 안전성에 대한 고찰

서광욱(Kwang Wook Suh),이우철(Woo Cheol Lee),박정수(Cheong Soo Park) 대한두경부종양학회 1992 대한두경부 종양학회지 Vol.8 No.1

To clarify the safety of both total and near-total thyroidectomy, and to guide a selectionof an adequate type of surgical treatment of thyroid diseases, 192 consecutive total or near-total thyroidectomy cases were reviewed. They were divided into two groups: ont, the total thyroidectomy group(Group T,N=111) and the other, the near-total thyroidectomy group (Group NT, N=81). In both groups, complication rates, associations of complication rates with extents of surgery and stage of lesion were observed. Complication rate was significantly higher in Group T (53.6% vs 12.3%, p<0.05). But the rate of permanent complications such as permanent hypoparathyroidism and recurrent laryngeal nerve injury was remarkably low(4.5% in Group T, 6.0% in Group NT) and shows no significant difference in both groups. There was no permanent complication in cases where any type of neck dissection had not been performed regardless of the type thyroidectomy. But among whom underwent central compartmental neck dissection(CCND) and functional neck dissection(FND), 4(4.4%) and 4(6.4%) cases showed permanent complications. There was no statistical significance in differences between Group I and NT. In cases who underwent concomittant classical radical neck dissection(RND), 3(25.5%) showed permament complications. In this subgroups, complications were significantly higher in Group T(p<0.005). Complications were also directly related to the stage of the lesion. Only one patient showed permanent complication in 74 intracapsular lesions but 9 permanent complications were observed in 118 advanced lesions. We could clarify both total and near-total thyroidectomy were safe operations and the complications were related to accompanying neck dissections and the disease status rather than total or near-total thyroidectomy itself. Thus, we think that for the cases where higher complication rates are expected, such as locally advanced thryoid cancers or the cases which required wider neck dissection, the near-total thyroidectomy would be a preferrable method.

그레이브스병의 수술적 치료방법

성태연(Tae-Yon Sung),김연선(Yon Seon Kim),이숙현(Sook Hyun Lee),윤종호(Jong Ho Yoon),홍석준(Suk-Joon Hong) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.2

Purpose: Subtotal thyroidectomy has been the standard operation for Graves’ disease in achieving a favorable outcome in recovery of euthyroid state. However, the postoperative outcomes following subtotal thyroidectomy differ by surgeon and postoperative thyroid dysfunctions develop as time passes. Here, we have studied the validity of total thyroidectomy for Graves’ disease patients, with a comparison to subtotal thyroidectomy. Methods: A total of 299 patients with Graves’ disease underwent thyroid operation consecutively in Asan Medical Center, Seoul, Korea from December 1995 to December 2005. Among them, 241 cases had subtotal thyroidectomy and 43 had total thyroidectomy. The subtotal thyroidectomy cases were divided into 3 groups according to estimated remnant thyroid; <4 g, 4≤∼<6 g and ≥6 g. Also, according to postoperative thyroid function, the patients were divided into euthyroid, hypothyroidism and hyperthyroidism groups. The postoperative changes of thyroid function, postoperative complications and hospital days were analyzed. Results: In subtotal thyroidectomy, postoperative thyroid function showed euthyroid in 25 (10.4%), hypothyroidism 206 (85.5%) and hyperthyroidism 10 (4.1%). However, total thyroidectomy showed no persistent hyperthyroidism or recurrence. The postoperative thyroid function state changed in 24 patients out of 148 who had more than 2 years postoperative follow-up. Hyper-functional changes developed with higher rates (Hypo-6 vs. hyper-18). The postoperative complication rate was higher in subtotal thyroidectomy including bleeding, hoarseness and hypocalcemia. Conclusion: In our study, the patients showing normal thyroid function after subtotal thyroidectomy were very limited and thyroid dysfunction developed continuously with time lapse, especially towards hyperthyroid state. Therefore, we suggest that total thyroidectomy should be considered as a treatment option in Graves’ disease.

Total Thyroidectomy in the Mouse: the Feasibility Study in the Non-thyroidal Tumor Model Expressing Human Sodium/Iodide Symporter Gene

Shim, Hye-Kyung,Kim, Seog-Gyun,Kim, Tae-Sung,Kim, Seok-Ki,Lee, Sang-Jin The Korea Society of Nuclear Medicine 2011 핵의학 분자영상 Vol.45 No.2

Purpose This study sought to probe the feasibility of performing total thyroidectomy in the mouse using a nonthyroidal hNIS expressing tumor model. Materials and Methods Our thyroidectomy protocol included thorough excision of both lobes and the isthmus. For evaluating the completeness of thyroidectomy, we compared the $^{99m}Tc$-pertechnetate scans taken before and after thyroidectomy. The prostate cancer cell line was subcutaneously inoculated 2 weeks after the thyroidectomy. When the tumor reached 5-10 mm in diameter, Ad5/35-E4PSESE1a-hNIS was injected intratumorally, and $^{131}I$ scans were performed. The radioiodine uptakes of the neck and the tumor were compared with those of the other regions. Results Total thyroidectomy was performed in 13 mice. Although 38.5% died during or just after thyroidectomy, the others survived in good health for 2 months. Thyroid tissue was completely eliminated using our protocol; the residual uptake of $^{99m}Tc$-pertechnetate was minimal in the neck area. The neck/background uptake ratio after thyroidectomy was significantly lower than that before thyroidectomy (p<0.05). Non-thyroidal tumor models were successfully established in all the surviving mice. Radioiodine accumulation in the tumors was visualized on $^{131}I$ scans, and the neck uptakes were minimal. Conclusion Using our total thyroidectomy protocol, we successfully established a hNIS-transfected prostate cancer model with a minimal accumulation of radioiodine in the neck. The relatively high mortality after surgery can be a problem, and this might be reduced by minimizing the surgical stress.

갑상선유두암에서 갑상선전절제술과 중심경부림프절절제술 후 발생하는 저칼슘혈증 예측 인자 연구

이옥주(Ok Joo Lee),김형철(Hyung Chul Kim),임철완(Cheol Wan Lim),신응진(Eung Jin Shin),조규석(Gyou Suk Cho),정준철(Jun Chul Jung),정귀애(Gui Ae Jung),김지선(Zisun Kim),정재홍(Jae Hong Jeong),최규성(Kyusung Choi),한선욱(Sun Wook Han),허 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.3

Purpose: Total thyroidectomy with central lymph node dissection (CLND) is a treatment modality of choice for thyroid cancer. Hypocalcemia is the most common complication after total thyroidectomy. The aim of the current study was to determine the association between surgery-related clinical factors and postoperative hypocalcemia. Methods: A prospective analysis was performed for 101 patients who underwent total thyroidectomy with CLND for papillary cancer from June 2013 to June 2014. Correlation between clinicopathologic factors and postoperative hypocalcemia was analyzed. Results: Based on the postoperative day-2 calcium, 56 patients (55%) developed hypo-calcemia and 45 patients (45%) were normal. No significant differences in histopathologic (tumor size, tumor focality, histologic type, number of retrieved lymph nodes, metastatic lymph node, thyroiditis, retrieved parathyroid gland) findings were observed between the hypocalcemia group and normal calcium group. Mean value of the postoperative day-0 parathyroid hormone (PTH) was significantly lower in the hypocalcemia group (hypoca1cemia group: 14.3±9.4 pg/mL; normal group: 25.0±16.4 pg/mL; P<0.001). In logistic regression analysis, postoperative PTH was a factor significantly affecting postoperative hypocalcemia (OR 0.93; CI: 0.90-0.97; P<0.001). In ROC analysis, the cut-off value of PTH was 19.965 (sensitivity 79%, specificity 58%), and area under the curve (AUC) was 0.709 (95% CI: 0.607-0.811). Conclusion: Postoperative PTH was a factor predicting hypocalcemia after total thyroidectomy with CLND. Use of postoperative PTH as a screening tool for prediction of postoperative hypocalcemia would be useful in management of patients with hypocal-cemia.

갑상선 전절제술의 안정성

윤효영,장이찬,최재운 충북대학교 의과대학 충북대학교 의학연구소 1998 忠北醫大學術誌 Vol.8 No.1

연구목적 : 갑상선암의 외과적 치료는 갑상선의 부분절제술에서 갑상선 전절제술까지 다양한 수술이 적용되고 있다. 갑상선 전절제술은 술후 영구적 칼슘저하증 및 반회후두신경 손상의 위험성에도 불구하고, 최근에는 갑상선암에서 그 적용 빈도가 증가하고 있다. 충북대학교병원 외과에서 갑상선 전절제술을 시행한 26명의 환자를 대상으로 국소 합병증을 조사하여 갑상선 전절제술의 안정성을 알아보고자 하였다. 대상 및 방법 : 1993년 1월부터 1997년 12월까지 충북대학교병원 외과에서 갑상선암으로 갑상선 전절제술을 시행한 26명의 환자의 의무기록을 바탕으로 갑상선 전절제술후의 국소 합병증에 대하여 후향적으로 조사하였다. 결과 : 26명의 환자중 9명의 환자에서 총 11례의 국소 합병증이 발생하였다. 이중 술후 출혈 1례(3.8%), 일시적 애성 1례(3.8%), 영구성 애성 1례(3.8%), 일시적 칼슘저히증 5례(19.2%), 영구적 칼슘저히증 2례(7.7%), 흉관 손상 1례(3.8%)등이 있었으나 수술에 의한 사망 환자는 없었다. 결론 : 갑상선 전절제술후의 국소 합병증은 생각보다 높지 않아 갑상선암에서 우선적으로 고려 할 수 있겠다. Purpose : Surgical management of thyroid cancer varies from partial resection to total thyroidectomy with or without lymph node dissection. In spite of the risk of hypoparathyoidism and recurrent laryngeal nerve injury after total thyroidectomy, the frequency of this operation is increasing recently. We reviewed 26 total thyroidectomies performed at our hospital to evaluate local complication and risk after total thyroidectomy. Materials and Methods : We reviewed medical records of 26 patients who underwent total thyroidectomy due to thyroid cancer from January 1993 to December 1997. Results : The eleven postoperative local complication occurred in 9 patients among 26 patients : postoperative bleeding in (3.8%), temporary hoarseness in 1(3.8%), permanent hoarseness in 1(3.8%), temporary hypoparathyroidism in 5(19.2%), permanent hypoparathyroidism in 2(7.7%), thoracic duct injury in 1(3.8%) without postoperative mortality. Conclusion : The incidence of complications after total thyroidectomy is not so high that it should be consider as the primary treatment of thyroid cancer.

하시모토갑상선염 동반여부에 따른 갑상선전절제술 후 부갑상선기능저하증의 특징 분석

이동명,김은영,정일용,김성엽,안은정,박종민,박세혁,윤여규,Dongmyung Lee,Eunyoung Kim,Ilyong Chung,Seongyup Kim,Eunjung Ahn,Jong-min Park,Seihyeog Park,Yeo-Kyu Youn 대한갑상선-내분비외과학회 2014 The Koreran journal of Endocrine Surgery Vol.14 No.4

Purpose: The characteristics of hypoparathyroidism in patients with Hashimoto thyroiditis (HT) after total thyroidectomy are not well established. The aim of this study was to investigate the relationship between hypoparathyroidism and loss of parathyroid glands in patients with or without HT who underwent total thyroidectomy. Methods: Patients who underwent total thyroidectomy were divided into two groups; with HT (n=166) and without HT (n=526). Clinicopathologic characteristics were compared between the two groups. Results: The mean numbers of parathyroid glands in specimens were significantly smaller in the with HT group than in the without HT group (0.34±0.51 vs. 0.42±0.58, P=0.003). The rate of transient hypoparathyroidism was significantly higher in the with HT group than in the without HT group (51.8% vs. 34.6%, P=0.000). Serum total calcium levels in patients who experienced transient hypoparathyroidism did not differ significantly between groups (P=0.335). The incidence of transient hypoparathyroidism of patients who preserved all four parathyroid glands or sacrificed one parathyroid gland was higher in the with HT group than in the without HT group, although that of patients who sacrificed two or more parathyroid glands was similar between groups. The incidence of permanent hypoparathyroidism in the two groups did not differ (P=0.546). Conclusion: Patients with HT had a higher rate of transient hypoparathyroidism after total thyroidectomy, particularly patients who preserved all four or three parathyroid glands. It is likely that the blood supply to the parathyroid gland might be vulnerable in patients with HT. Therefore, even though all parathyroid glands were preserved, careful monitoring of hypoparathyroidism is necessary after total thyroidectomy in patients with HT.

갑상선 전절제술 후 저칼슘혈증

남기현(Kee-Hyun Nam),윤지섭(Ji-Sup Yun),이용상(Yong Sang Lee),정종주(Jong Ju Jeong),장항석(Hang-Seok Chang),정웅윤(Woong Youn Chung),박정수(Cheong Soo Park) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.3

Purpose: Postoperative hypocalcemia is a common complication of thyroidectomy. This study evaluated the incidence and risk factors for postoperative hypocalcemia after total thyroidectomy. Methods: There were 196 consecutive patients undergoing total thyroidectomy for thyroid cancer between September 2004 and February 2005 who were enrolled in this study. Patients were divided into two groups, those remaining normocalcemic (Group Ⅰ) and those who had hypocalcemia requiring treatment (Group Ⅱ). Group Ⅱ was subdivided into a transient hypocalcemic group (Group ⅡA) and a permanent hypocalcemic group (Group ⅡB). All groups were compared with regard to age, gender, histology, coexisting disease, T stage, bilateral lesions, primary total thyroidectomy versus secondary completion thyroidectomy, extent of lymph node dissection, and autotransplantation of the parathyroid gland. Results: Among all patients, 139 (71%) were in Group I, 54 (27.5%) in Group ⅡA and 3 (1.5%) in Group ⅡB. On the multivariate analysis for risk factors compared between Group Ⅰ and Group Ⅱ, the T4 stage was the most significant for the development of postoperative hypocalcemia. On the univariate analysis comparing factors between Group ⅡA and Group ⅡB, the T4 stage and a complete thyroidectomy were significantly related to the development of permanent hypocalcemia. Conclusion: The results of this study showed that the incidence of transient hypocalcemia, after total thyroidectomy, was 27.5%, while permanent hypocalcemia was detected in 1.5% of cases. The parathyroid glands should be preserved more carefully to avoid postoperative hypocalcemia in patients with high risk factors including T4 tumors and complete thyroidectomy procedures.

유두갑상선암의 고식적 갑상선전절제술과 내시경하 갑상선전절제술 후 부갑상선 보존율 비교분석

김정빈,박인석,조현진,곽금희,양근호,배병노,김기환,한세환,Jungbin Kim,Inseok Park,Hyunjin Cho,Geumhee Gwak,Keunho Yang,Byungnoe Bae,Kiwhan Kim and Sehwan Han 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.2

Purpose: Incidental parathyroidectomy is the most common and unexpected consequence of a total thyroidectomy. It can cause hypocalcemia symptoms such as muscle cramping and even seizures. We conducted this study to compare several factors including the preservation rate of parathyroid glands during both a bilateral axillo-breast approach endoscopic thyroidectomy (BABA) and a conventional open thyroidectomy (CT) for papillary thyroid carcinomas. Methods: We retrospectively reviewed the medical records of 299 papillary thyroid cancer patients who had a total thyroidectomy between January 2008 and December 2011. We grouped the patients into two groups: BABA (n=70) and CT (n=229). We analyzed age, tumor size, operation time, the number of preserved and removed parathyroid glands, amount and duration of seroma drainage, pain score, hypocalcemia symptoms, and serum total calcium level in both the BABA and CT groups. Results: We observed a younger age (under 45 years old) (P=0.000), smaller tumor size (P=0.000), longer operation time (P=0.000), larger amount of drainage (P=0.000), longer duration of drainage (P=0.007), and larger pain score (P=0.000) in the BABA group. Of the 70 patients that received an endoscopic thyroidectomy, we preserved all four parathyroid glands in 56 patients (78.6%). Of the 229 patients that received an open thyroidectomy, we preserved all four parathyroid glands in 141 patients (61.6%, P=0.004). Conclusion: BABA results in more extensive tissue damage over a longer period of time than CT. However, BABA was an excellent method for preserving parathyroid glands when compared with CT for thyroid carcinoma. Thus, it seems to be feasible performing BABA when it matches the indications. (Korean J Endocrine Surg 2012;12: 0-101)

Comparison of Natural Drainage Group and Negative Drainage Groups after Total Thyroidectomy: Prospective Randomized Controlled Study

우승훈,김진평,박정제,심현석,이상하,이호중,원성준,손희영,김록범,손영익 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.1

Purpose: The aim of this study was to compare a negative pressure drain with a natural drain in order to determine whether a negative pressure drainage tube causes an increase in the drainage volume. Materials and Methods: Sixty-two patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) were enrolled in the study between March 2010 and August 2010 at Gyeongsang National University Hospital. The patients were prospectively and randomly assigned to two groups, a negative pressure drainage group (n=32) and natural drainage group (n=30). Every 3 hours, the volume of drainage was checked in the two groups until the tube was removed. Results: The amount of drainage during the first 24 hours postoperatively was 41.68±3.93 mL in the negative drain group and 25.3±2.68 mL in the natural drain group (p<0.001). After 24 additional hours, the negative drain group was 35.19±4.26 mL and natural drain groups 21.53±2.90 mL (p<0.001). However, the drainage at postoperative day 3 was not statistically different between the two groups. In addition, the vocal cord palsy and temporary and permanent hypocalcemia were not different between the two groups. Conclusion: These results indicate that a negative pressure drain may increase the amount of drainage during the first 24-48 hours postoperatively. Therefore, it is not necessary to place a closed suction drain when only a total thyroidectomy is done.