胸骨后甲状腺肿物的外科治疗

Surgery of substernal goiter

目的 探讨胸骨后甲状腺肿物切除手术入路及方法。方法 回顾分析 2 7例胸骨后甲状腺肿物临床资料。结果 2 7例胸骨后甲状腺肿物患者接受外科治疗 ,均获成功。其中结节性甲状腺肿 10例 ,甲状腺腺瘤 9例 ,结节性甲状腺肿癌变 4例 ,甲状腺乳头状癌伴气管旁淋巴结转移 3例 ,甲状腺滤泡状癌伴气管旁和纵隔淋巴结转移 1例。 2 3例 (良性病变 19例 ,恶性肿瘤 4例 )颈部低位领式切口入路切除 (占 85 2 %) ,3例颈部低位领式切口并胸骨正中劈开入路的占 11 1%,1例开胸入路并颈部低位领式切口入路切除 (占 3 7%)。术后并发症发生率为 2 5 9%,其中术后伤口出血较为常见 ,占 42 9%。结论 颈部低位领式切口入路切除胸骨后甲状腺肿物是可行的 ,它容易操作 ,安全可靠 ,又具有损伤小、并发症少等优点。

Objective To study the surgical approaches and operative techniques for substernal goiter. Method A retrospective study of 27 cases with substernal thyroid nodules was made in our hospital. Result The operations on 27 patients with substernal uodules have been successfully carried out. Among them, 10 were goiters, 9 adenomas, 4 malignancy and 4 were thyroid cancer metastasizing to paratracheal or substernal nodes. Resection via cervical collar incision was adequate in 23 cases. Three thyroid cancers with paratracheal node metastasis were completely resected by sternotomy and only one thyroid cancer with paratracheal and substernal nodes metastasis was resected by combined thoracotomy and cervical collar incision. Conclusion Resection via cervical collar incision for all retrosternal thyroid nodules were advised. The preliminary experience with this procedure suggests that it has some advantages in the management of substernal goiter, including: ① ease of operation compared to both sternotomy and thoracotomy; ② relatively low morbidity; ③ safe and reliable.