霍纳综合征(HS),由3-神经元眼交感神经通路(ONP)的病变引起,包括三合会:眼睑下垂,瞳孔缩小和无汗症(同侧ONP损伤)。甲状腺相关HS代表甲状腺结节/甲状腺肿/癌症HS(T-HS)下方的异常实体,和甲状腺切除术后HS(Tx-HS)。我们的目标是概述Tx-HS。这是一个叙述性的审查。我们修订了PubMed出版,全长,英语论文从开始到2022年11月。此外,我们介绍了甲状腺切除术后淋巴囊肿/乳糜漏(Tx-L)的数据,并引入了同时患有Tx-HS和Tx-L的新儿科病例。Tx-HS:统计证据的水平与孤立病例报告不同,分析甲状腺切除术后并发症大小组的研究报告HS中最罕见的副作用(与低钙血症相反),或由于各种疾病而导致的不同系列的HS患者,包括T-HS/Tx-HS。Tx-HS与良性或恶性甲状腺疾病有关,不管手术的类型。T-HS的术前比率为0.14%;Tx-HS的术后比率在0.03%至5%之间(大多数,确定了0.2%);描述了内窥镜而不是开放式手术的可能较高的风险。HS表格不完整,和儿科发病被确定,也是;最早的鉴定是在干预后2小时后。在大多数情况下,在前2-6个月至一年内,预期会逐渐缓解。管理大多是保守的;一些使用糖皮质激素和神经营养剂。一个主要的陷阱是一个额外的因素,如手术后收集引起的局部压迫(血肿,囊肿,瘘管,Tx-L)及其校正可改善结果。预后可能取决于颈交感神经链(CSC)病变的严重程度:间接,局部压迫性肿块造成的轻度损伤,CSC的术中损伤,如缺血和牵开器对CSC的拉伸与HS恢复有关,而CSC部分是不可逆的。其他医源性因素是:甲状旁腺的手术内操作,甲状腺微波/射频消融,和高强度聚焦超声,并经皮给甲状腺结节注射乙醇.Tx-L,很少报告(主要是0.5%,除了一项研究中8.3%的比例),与扩展手术相关,尤其是外侧/中央颈夹层,和先天性异常淋巴管的存在;是的,还,在内窥镜手术和胸乳入路后描述;它在手术后几天内开始。通常低脂饮食(甚至空腹和父母营养)和引流管是有用的(作为保守管理的一部分);一些使用奥曲肽,像高渗葡萄糖这样的局部密封溶液,Viscum专辑摘录,2-氰基丙烯酸正丁酯。在严重的情况下,由于淋巴和乳糜胸的风险,需要重新干预。早期识别Tx-HS和Tx-L可改善结果。一些医源性并发症是不可避免的,仍然需要多因素预测模型,还考虑到标准化的操作程序,熟练的手术内操作,并对患者进行术后密切随访,尤其是在现代时期,甲状腺手术取得了巨大进展,患者可以提前出院。
Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid−related HS represents an unusual entity underling thyroid nodules/goiter/cancer−HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2−6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients.