外科治疗胸内甲状腺肿的临床研究

Clinical Study of Surgical Treatment of Intrathoracic Goiter

目的探讨外科治疗对胸内甲状腺肿的治疗意义与手术方式的选择。方法回顾性分析2004年1月至2010年12月在我院胸外科接受手术治疗的52例胸内甲状腺肿患者的术前检查、手术治疗情况与随访资料。结果根治性切除51例,姑息性切除1例。低位颈部领式切口45例(86.5%),低位颈部领式切口+胸骨正中小劈开4例(7.7%),右后外侧开胸3例(5.8%)。术后并发症总发生率为7.7%。52例患者中,失访者6例,1例甲状腺低分化癌患者于术后18个月死于肿瘤转移,余45例未见复发或死亡。结论外科手术治疗是胸内甲状腺肿治疗的首选。低位颈部领式切口因暴露佳、切除率高、创伤小、符合美观要求,适合绝大多数早期患者。肿块大伴外侵应在充分检查的基础上选择右后外侧切口第四肋间进胸进行探查切除。

Objective To investigate the clinical significance of surgical treatment in treating intrathoracic goiter and the choice among different surgical procedures.Methods 52 patients with intrathoracic goiter who were admitted into our hospital from January 2004 to December 2010 were selected in this study,whose preoperative examinations,surgical procedures,and follow-up date were retrospectively analyzed in this paper.Results All patients received surgical treatment,and 51 were radically resected and 1 palliatively;45 cases（86.5%）were resected via cervical collar incision,4 cases（7.7%） via cervical collar incision plus mini-sternotomy,3cases（5.8%）via right posterolateral thoractomy.All postoperative complication rate was 7.7%.Among 52 patients,6 cases lost follow-up,1 case died from metastasis of low-differentiation carcinoma of goiter 18 months after surgery,45 cases remained health and no sings of replacement.Conclusion Surgery is the first choice of treating intrathoracic goiter.The choice of different surgical procedures should depend on the location,size and the local invasion of the tumor.