巨大甲状腺肿手术治疗的进展

Advancement of operations for huge goitres

巨大甲状腺肿多由结节性甲状腺肿、甲状腺瘤引起，少数也可由甲状腺功能亢进、甲状腺癌引起。近年来，巨大甲状腺肿的发病率有所下降，临床上仍可见到。甲状腺肿可使颈部大血管、气管受压移位及变窄，故手术操作难度较大、风险较高和并发症较多。文中着重从术前检查、麻醉的选择、切口及引流的选择、手术方式、纤支镜在气管移位的应用、胸骨后甲状腺肿的处理、避免喉返和喉上神经损伤八个方面，对国内外近几年手术治疗进展情况进行综述。

Huge goiters are caused by nodular goiter, thyroid adenoma, minority hyperthyreosis and thyroid cancer. Incidence of huge goiters is descending, but huge goiters are often seen. Many patients have some degree of compression, replacement and bend of trachea and vessels of thyroid by the goiter. Operation is relatively difficult, corresponding operation risk is higher, and complications are more. This article focuses on eight aspects of operation therapy in huge goiters： preoperative examination, the selection of anaesthesia, the choice of incision and drainage, modus operandi, application of bronchofibroseope in patients with tracheal displacement,the disposal of substernal struma, avoiding injury of recurrent laryngeal nerve and superior laryngeal nerve. The aim of this review is to present the advancement of operation for huge goiters at hane and abroad.