Évolution des indications de la sternotomie en chirurgie thyroïdienne

From October 1984 to August 2005, 11,452 thyroidectomies were performed; 52 (0.45%) required a sternotomy. The patients included 32 women and 20 men. Sternotomy was total in 27 patients (52%) and partial in 25 (48%). Thirty patients (58%) had a benign goitre with intrathoracic extension, and 22 patients (42%) had thyroid malignancy. In 8 cases, the procedure was a reintervention. There were no post-operative deaths. Complications directly related to the sternotomy occurred in four patients (10%) and included one subcutaneous abscess, two cases of chylothorax (one requiring re-operation), and one pneumothorax. One patient developed a tight pseudoarthrosis of the sternotomy at eighteen months which caused neither pain nor functional disability.In comparing the first with the second decade of this study, we find that the incidence of sternotomy has not changed but that the indications have evolved. Initially sternotomy was indicated for benign intrathoracic goitres. More recently, thyroidectomy for malignancy, particularly in cases of re-operation, has been the major indication.Sternotomy is only rarely indicated in thyroid surgery. It adds moderately to hospital stay but does not increase morbidity when compared to the cervical approach.