经颈入路良性胸骨后甲状腺肿切除的手术技巧

Operation Skill for Removal of Benign Substernal Goiters Through Cervical Approach

目的探讨良性胸骨后甲状腺肿经颈入路切除的可行性与安全性并总结手术技巧。方法对我院2002年8月至2011年10月期间的85例良性胸骨后甲状腺肿患者的临床资料进行回顾性分析。结果 85例患者均经颈入路行胸骨后甲状腺肿切除,未发生围手术期死亡及呼吸道梗阻,无大出血、气胸、血胸及乳糜漏,未发生永久性喉返神经损伤及永久性甲状旁腺功能低下。3例患者术后1～3 d出现声音嘶哑,对症处理后恢复正常。4例患者术后1～2 d出现四肢末端麻木,1例患者出现轻度抽搐,予以静脉及口服补钙治疗3～7 d后症状缓解。术后颈部引流量(68±4.9)ml(35～220 ml),2～6 d(平均4.2 d)拔除引流管。术后2年82例患者得到随访,无低钙、低甲状旁腺激素的病例,无声音嘶哑及局部甲状腺肿复发的病例,2例患者出现甲状腺功能低下,给予调整口服甲状腺素剂量后恢复正常。结论坠入型良性胸骨后甲状腺肿经颈入路切除是安全、可行的,而充分的暴露、循序渐进的操作、寻准间隙的钝性分离和托拽结合是保证手术成功的关键。

Objective To explore the feasibility and safety of removal of benign substernal goiter through cervical approach and summarize the operation skill. Methods The clinical data of 85 cases diagnosed as benign substernal goiter from August 2002 to October 2011 in this hospital were analyzed retrospectively. Results The removal of benign substernal goiters in all 85 cases were performed through cervical approach without perioperative death, respiratory tract obstruction, massive haemorrhage, pneumothorax, hemothorax, chylus leakage, permanent impairment of recurrent laryngeal nerve, and permanent hypoparathyroidism. Three cases of hoarseness were found on 1-3 d after operation, which returned to normal after symptomatic treatment. Four cases of numbness in the extremities and one case of mild convulsion happened, the symptoms were relieved through intravenous and oral administration of calcium treatment in 3-7 d. The drainage volume was 35-220 ml with （68±4. 9） ml. The drainage tube was removed on postoperative 2-6 d with an average 4. 2 d. Eighty-two patients were followed-up in 2 years after operation, no low calcium, low parathyroid hormone, hoarseness, and local goiter recurrence occurred. Two cases of hypothyroidism returned to normal after oral thyroxine dose adjustment. Conclusions Removal of the downward benign substemal goiter through cervical approach is safe and feasible. Sufficient exposure, stepwise procedure, blunt dissection in the precise gap, and combination of lifting with upbearing are the surgical skills for success.