巨大甲状腺肿外科手术治疗体会

Surgical treatment of huge goiter：a report of 115 cases

目的 总结巨大甲状腺肿外科手术治疗的体会.方法 回顾性分析115例巨大甲状腺肿患者的临床资料.115例患者胸片显示气管均有不同程度的受压、偏曲,明显呼吸困难者10例（8.69%）.良性为102例（88.7%）,恶性 13例（11.3%）,115例行甲状腺次全切除或甲状腺全切,姑息切除术.结果 术中大出血2例（1.73%）,术后声音嘶哑3例（2.6%）.术后手足麻木3例（2.6%）,表现为双手麻木,严重抽搐.5例术后作气管切开,2例术中作气管悬吊,无手术死亡.结论 充分的围手术期准备、甲状腺血管的处理技巧、加强术中对神经和甲状旁腺的保护、呼吸困难的及时处理是手术治疗的关键.

Objective To sum up the experience of surgical treatments for huge goiter. Methods The clinical data of 115 cases of huge goiter were analyzed retrospectively. The trachea of all the 115 cases had some degree of oppression and replacement by the goiter confirmed by X - ray examina- tion. Among the 115 cases, 10 cases（8.69% ）had obvious dyspnea. Postoperative pathological diagnosis showed nodular goiter in all the 115 cases, including 102 cases （88.7%）presenting malignant. A total of 115 patients underwent subtotal,total thyroidectomy,or palliative excision. Results Two patients developed operative hemorrhage （ 1.73% ）, 3 patients presented with postoperative delayed - onset hoarseness （2.6%）, and 3 had numb hands and feet after the operation（2.6% ）. Five patients underwent tracheotomy post operation and 2 were subjected to suspension of the trachea during the operation. No operation - related death occurred. Conclusion The key for the success of the surgical treatments for huge goiter consists of complete preoperative preparation, careful surgical manipulation of thyroid vessels and protection of nerve and parathyroid glands during the operation and in - time treatment of dyspnea.