120例巨大甲状腺肿的外科治疗

Surgical Treatment of 120 Huge Goiters

目的:探讨巨大甲状腺肿外科治疗的特点与治疗要点。方法:收集我院17年间收治的甲状腺肿物患者3200例,并将重量在500g以上、肿块直径8cm以上的巨大甲状腺肿患者120例进行回顾研究。结果:巨大甲状腺肿占同期病例的3.8%。其中102例行一侧甲状腺叶切除加对侧次全切除,18例行甲状腺全切术,其中12例行甲状腺全切加颈部淋巴结清扫术。病理诊断105例为结节性甲状腺肿,甲状腺癌15例(12.5%),继发甲亢者20例(16.2%)。术后出现并发症者44例,其中包括术后甲状腺功能低下30例,甲状旁腺功能低下5例,单侧喉返神经损伤7例,双侧喉返神经损伤1例,气管软化塌陷1例,无死亡病例。结论:巨大甲状腺肿可合并胸骨后甲状腺肿,可压迫气管,使气管移位变窄,手术操作难度大,风险较高,并发症多。应选择合适的麻醉方法,根据不同情况作不同处理,避免大血管和喉返神经的损伤。

Objective To investigate the main problems of operation treatment for huge goiters. Methods Respective study of All 120 cases of huge goiter that weight is largeer than 500 gram, diameter larger than 8cm, as mean time the treamented goiter patients was 3200cases. Results Huge goiter account for 3.8% of all goiter patients at same time. 102 patients were subjected to one lobe thyroidectomy and one lobe subtotal thyroidectomy, 18 patients underwent total thyroidectomy , 12 cases underwent prophylactic peripheral lymph nodes （PLN） dissection. Pathologic diagnosis： 105 cases was goiter, carcinoma of thyroid was 15 cases, secondary hyperthyroidism was 20 cases. Postoperative complication was 44 cases, consist of hypothyroidism 30 cases, hypothyroidism hypoparathyroidism 5 cases, one later re- current laryngeal nerve injury 7cases, two later recurrent laryngeal nerve injury 1 cases , trachea soften and collapse 1 cases, no death occurred. Conclusion Operation for huge goiter is relatively difficult with correspondingly high opertion risk and morbidity. The operation therapy must focus on some aspects in huge goiters： preoperative examination, modus operandi, application of bronchofibroscopic in patients with tracheal displacement, the disposal of substernal gioter and prevention of complication.