胸骨后甲状腺病变的诊断及治疗

Management of patients with substernal goiters

1980～1997年我院手术治疗25例胸骨后甲状腺病患者，男8例，女17例，占我院同期甲状腺手术例数的1％。平均年龄57岁（36～70岁），男女比率为1：2．1。病变位于右侧14例，左侧7例，双侧4例。其大小平均为7．1cm×4．gcm（4cm×3cm～16.5cm×9cm）。以压迫气管症状最为常见，个别病例可无症状。主要体征为可随吞咽动作活动的不能触及下极的颈部包块、气管移位、颈胸静脉扩张。胸片特点：正位片示与锁骨重叠的前上纵隔阴影，伴气管移位或受压。多数病例可经颈部低位切口切除。

operations of substernal goiters were performed in 25 patients (male & and female1 7 ) from 1980 to 1997 in our hospital. It was 1 % of our thyroidectomies performed at the same period. The patient age ranged from 36 to 70 years (mean 57 years ). M/F was 1: 2. 1. The goiterswere located in the right anterior mediastinum in 14 cases,left in 7 and bilateral in 4. The size ofgoiters varied from 4cm × 3cm to 16. 5cm × 9cm (mean 7. 1cm× 4.9cm). Airway compression wasthe commonest finding. The chief physical findings were cervical mass which was unable to palpateand was movable when the patient swallowed, deviation of the trachea, dilated neck and thoracicveins. Chest radiograph: the overlap of clavicle with the upper anterior mediastinal shadow, tracheadeviation and narrowing. Most of cases can be removed through a low cervical incision.