胸内甲状腺肿的外科治疗

Surgical treatment of intrathoracic goiter.

目的 探讨胸内甲状腺肿的诊断方法及手术方式。方法 收集 195 8～ 2 0 0 0年间经病理证实为胸内甲状腺肿 6 5例。结果 主要依靠临床症状、X线、同位素扫描、CT检查诊断。肿物下极在主动脉弓上缘水平以上者 41例 (6 3 1% ) ,在此水平以下者 2 4例 (36 9% )。均行手术治疗 ,手术径路分为颈部领式切口 41例(6 3 1% ) ,低位领式切口加胸骨正中切开 11例 (17 0 % ) ,开胸 18例 (12 3% ) ,颈胸联合切口 3例 (4 6 % ) ,胸骨正中切开 2例 (3 0 % )。术后并发症发生率 15 4% ,其中喉返神经损伤发生率 7 7% ;死亡率为 1 5 %。结论 手术切除是胸内甲状腺肿的首选治疗方法 ,喉返神经损伤是术后主要并发症 ,应注意预防其发生。并依据肿物不同情况采取不同的手术径路 ,宜先行衣领式切口 ,估计操作困难 ,病变达主动脉弓下者 ,应行胸骨切开或开胸处理。

Objective This paper mainly discusses the diagnosis and operation of the intrathoracic goiters. Methods 65 cases of intrathoracic goiters which were resected and pathologically proved in our department from 1958 to 2000 were presented. Results 63\^1% of the enlarged thyroid mass was located above the level of the aortic arch and 36\^9% were below that level.Resection via cervical collar incision was performed in 63\^1% of all cases,sternotomy in 17\^0% and thoractomy in 12\^3%.Complicational rate was 15\^4%,while the rate of recurrent laryngeal nerve paralysis was 7\^7%.Death rate was 1 5%. Conclusion The standard chest roentgenogram,computed tomogram and radioisotopescanning are of diagnostic help.Surgical intervention is the treatment of choice,and the routine approaches are cervical collar incision,sternotomy and thoracotomy.Surgery iva cervical collar incision for all retrosternal thyroid nodules was advised and sternotomy or thoracotomy are suggested.