胸骨后甲状腺肿物的手术处理

Surgery of substernal thyroid goiter

为探讨胸骨后甲状腺肿物手术切除的进路方式，回顾性分析３０年来外科治疗的结果。１９６５年至１９９４年间全部患者共８７例，其中结节性甲状腺肿６４例，占７３．６％；甲状腺腺瘤１３例，占１４．９％；甲状腺恶性肿瘤１０例，占１１．５％。通过颈部入路手术切除的占７０％（６１／８７），胸骨正中劈开切除的占１６％（１４／８７），前切口开胸切除的占１４％（１２／８７）。随着经验的积累，除误诊为纵隔其它来源的肿物外，１９８０年以后已不再行前切口开胸手术切除，１９８５年以后的４３例中，只有１例胸骨后结节性甲状腺肿的患者行胸骨劈开手术，其余均从颈部入路手术。由于颈部入路相对并发症少、损伤小、安全可靠，建议对良性的胸骨后甲状腺肿物和部分恶性肿物行颈部衣领式切口手术。

A retrospective study on 87 substernal thyroid nodules operated between 1965 and 1994 was made.Among them73.6% were goiters,14.9% adenoma and 11.5% malignancy.Resection via cervical collar incision was performed in 70% of all cases,sternotomy in 16% and thoracotomy in 14%. A cervical collar incision was adequete in 91% of 43 cases after 1985,only one goiter was completed by sternotomy. Morbidity rate was 41.4%,while the rate of recurrent laryngeal nerve paralysis was 20.7%. Surgery via cervical collar incision for all retrosternal thyroid nodules was advised and sternotomy or thoracotomy are suggested.