甲状腺再手术的时机及入路方式探讨

Opportunity and surgical approaches of thyroid reoperation

目的探讨甲状腺再手术的时机及手术入路方式。方法对我院2000年1月至2006年1月收治的94例甲状腺再手术患者的临床资料进行回顾性分析,主要分析再手术的时机及手术入路方式与操作难易程度的关系。结果本组病例行双侧甲状腺全切除术16例,一侧甲状腺切除并峡部切除术27例,一侧甲状腺切除术并对侧大部切除45例,单侧残余甲状腺切除加部分颈前肌群切除5例,单侧全切加同侧颈淋巴结清扫1例,再手术时间与初次手术相距4d～28年。手术入路:正中入路34例,胸锁乳突肌内侧入路23例,经胸骨舌骨肌、胸骨甲状肌间侧入路25例,正中入路加侧入路12例。手术时间1.5～2.5h,平均2.0h。结论甲状腺包块切除术后病理诊断甲状腺癌的再手术患者尽早手术。结节性甲状腺肿复发再手术的患者应作好充分术前准备,合并呼吸困难的甲状腺再手术患者采用正中入路易于松解气管前瘢痕粘连,缓解气管压迫症状;无呼吸困难症状者采用侧入路或正中入路与侧入路结合,简化手术操作、减少手术并发症。

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 ap- proaches 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.