巨大甲状腺肿手术切除要点与难点

Excision of huge goiter:Its key points and difficulties

目的探讨影响巨大甲状腺肿手术成功的因素。方法对2008年2月-2011年9月在我科确诊为巨大甲状腺肿28例患者,采用手术治疗,手术方式为甲状腺全切除术或次全切除术,并对大部分病例随访1年余。结果 28例均顺利完成手术。手术时间60-120 min,平均85 min,术中出血20-60 ml。4例给予气管悬吊术,3例术中行气管切开术,2例出现暂时性喉返神经麻痹,2例出现口唇麻木感,术后住院时间为5-14 d,平均7 d。4例患者术后病理回报为结节性甲状腺伴微小乳头状癌。结论良好的术野暴露、丰富的解剖知识、轻柔的操作、细致的组织辨别以及合理的手术方式是成功切除巨大甲状腺肿的重要因素。

Objective To study the factors for success excision of huge goiter.Methods Twenty-eight patients with huge goiter admitted to our department from February 2006 to September 2011 were included in this study.They underwent total thyroidectomy or subtotal resection and were followed up for more than one year.Results The huge goiter was successfully removed in all patients.The operation time was 60-120 min（mean 85 min） with an intra-operative blood loss of 20-60 ml.Of these patients,4 underwent tracheal suspension surgery and 3 underwent tracheotomy,during which temporary recurrent laryngeal nerve paralysis occurred in 2 and lip numbness in 2.Their hospital stay time was 5-14 days（mean 7 days）.Biopsy showed nodular goiter accompanying micropapillary carcinoma in 4 patients after operation.Conclusion Good exposure,rich anatomy knowledge,careful operation mode,meticulous tissue discrimination,and rational procedure are the key factors for successful excision of huge goiter.