胸内甲状腺肿的外科治疗

Surgical treatment of intrathoracic goiter

目的总结胸内甲状腺肿外科治疗经验，探讨其分类、临床特点和诊断方法。方法回顾性地分析１９８０～１９９８年７５例胸内甲状腺肿的外科治疗，其中４９例经单纯颈切口，１９例采用颈切口加上端胸骨劈开，７例经胸后外侧切口。结果围术期无死亡病例，术后无严重并发症发生。呼吸困难、吞咽不畅、上腔静脉阻塞及声音 嘶哑等症状逐渐地完全消失。结论ＣＴ扫描具有诊断价值。先进的麻醉技术和小口径的气管插管为手术成功提 供保证。手术切除为首选方法，一般病例均能经颈部切口完成，但对原发性胸内甲状腺肿、术后复发和恶性者需纵 劈胸骨以确保安全。

Objective To review the experience of surgical management of intrathoracic goter,this study was to assess the clinical types,manifestation,and diagnosis of it.Methods 75 patients with intrathoracic goiter undergoing in our hospital between 1980 and 1998 were analysed retrospectively,a transverse cervical incision was used in 49 cases,a combined cervical and sternotomy approach was used in 19 cases,posterolateral thoracotomy was used in 7 cases. Results No operative deaths occurred. No patients had postoperative serious complications. Obstructive airway signs,dysphagia,Superior vena cava syndrome,and other hoarseness symptoms generally disappeared completely. Conclusions Computed tomography is the most useful studies in evaluating a intrathoracic gotter. Advances in anesthetic techniques and the use of small-caliber endotracheal tubes facilitated the proper perioperative management. Surgical intervention is the treatment of choice,resection of intrathoracic goiters generally can be accomplished through a transcervical approach,but primary intrathoracic goiters,recurrent goiters,and malignant goiters often require a median sternotomy for safe removal.