Opportunity and surgical approaches of thyroid reoperation

Objective To investigate the opportunity and surgical approach of thyroid reoperation.Methods Ninety-four patients subject to thyroid reoperation were retrospectively analyzed from January 2000 to January 2006.Results The surgical procedures were as follows in all these patients:bilateral thyroid total excision(16 cases),unilateral residual thyroid excision and excision of thyroid isthmus(27 cases),unilateral residual thyroid excision and contralateral thyroid subtotal excision(45 cases),unilateral remnant thyroid excision and anterior cervical muscular group partial excision(5 cases),unilateral remnant thyroid excision and neck lymph node complete excision(1 cases).The surgical approaches were as follows in this group:middle approach(34 cases),lateral approach(24 cases),the lateral approach between sternohyoid muscle and sternothyroid muscle(25 cases),middle approach and lateral approach(12 cases).The operative time was 1.5～2.5 h(mean 2 h).Conclusion The patients with thyroid malignant neoplasm diagnosed by pathological examination post-operation should be subjected to the reoperation as soon as possible.These patients with nodular goiter recurrece post operation should be performed operation enough before secondary operation.These patients without respiratory difficult and repressed trachea should be completed the second operation by middle entrance,so as to lyses the adhesion before respiratory tube and recessed respiratory difficult syndrome.These patients with no respiratory difficult and trachea should be completed the second operation by lateral entrance or middle excision connected lateral entrance,so as to simplify operative management and decrease operative complication.