胸骨后甲状腺病变的诊断和治疗

Diagnosis and Treatment of Patients with Retrosternal Thyroid Lesion

目的 探讨提高胸骨后甲状腺 (retrosternalthyroid ,RT)的诊治水平。 方法 回顾性分析 115例RT患者 ,其邻近器官压迫为常见症状 ,有甲亢症状者 16例 ,主要体征为不能触及下极的颈部包块、气管移位、颈胸静脉扩张 ,吞咽时多数不能扪及甲状腺下极。首次手术 110例 ,5例为颈部术后复发再次手术。 结果 10 5例颈部低位领状切口 ,7例加劈开胸骨 5cm ,3例气管内麻醉下开胸手术。行预防性气管切开 12例。术中术后无死亡病例。病理结果显示 :良性病变者 83例 ,其中 3例复发 ;3 2例恶性病变 ,其中 2例未分化癌术后 4月死于全身转移 ,1例髓样癌术后 18个月死亡 ,余均术后生存超过 3年 ,其中 2 2例超过 5年。 结论 RT诊断并不困难 :颈胸部X线检查、放射性核素扫描及CT检查可明确程度及性质 ;RT为手术绝对适应证 ,对无症状患者也应早期手术 ;多数病例可采用颈部切口 ,少数需劈开胸骨 ,而迷走性RT则需开胸手术 ;合并气管软化者预防性气管切开有助于避免术后呼吸道梗阻。

Objective To investigate the efficient diagnosis and treatment of retrosternal thyroid(RT). Methods 115 cases of RT were retrospectively analysed . Adjacent organ compression was the commonest finding. 16 cases had hyperthyroidism. The chief physical findings were a cervical mass with unreachable lower extremity and deviation of the trachea, dilated neck and thoracic veins and non palpable lower thyroid pole during swallowing. 110 cases underwent primary operation, and 5 cases received second operation because of relapse. Result One hundred and five cases were operated through a low cervical curve incision. Seven cases required additional sternal split.Three cases had their chest open under intratrached anaesthesia.12 patients underwent prophylatic tracheotomy.Pathologic findings revealed: benign change in 83, malignant masses in 32. Three cases of benign goiters recurred. Two cases of undifferentiated carcinoma died of generalized metastasis.One patient of medullary carcinoma died 18 months later. Other patients of the malignant category survived for 3 years, of which 22 cases survived for 5 years after the operation. Conclusion It is not difficult to diagnose RT correctively. Cervico thoracic X ray film, radioactive isotope and CT checking can ensure the extent and character of the retrosternal part. RT possesses absolute indication of operation.For patients without symptom, it is also proper to operate as early as possible. Most of the mass can be removed through a low cervical incion.Some need additional sternum split. For aberrant RT,thoracotomy is required. Prophylatic tracheotomy is helpful to prevent respiratory tract obstruction after the operation.