胸骨后甲状腺肿瘤34例的外科治疗

Surgical management of substernal goiter

目的探讨胸骨后甲状腺肿瘤的诊断及手术方法。方法回顾性分析了 1982～ 1998年手术治疗的胸骨后甲状腺肿瘤 34例 ,对其术前检查、手术方法、术后并发症进行分析研究。结果胸骨后甲状腺肿瘤发病率约为 4 % (34/ 92 0 ) ,女性多见于男性 ;恶性肿瘤 5例 ,约占 15 % (5 / 34)。术前X线检查发现气管移位 7例、约占 2 1% (7/ 34) ,食管受压 6例、约占 18% (6 / 34) ;计算机体层摄影(CT)、磁共振 (MRI)检查发现颈部大血管移位 3例 ,约占 9% (3/ 34)。胸部平片与CT检查的确诊率分别为 82 %和 94 %。结论胸骨后甲状腺肿一般可经颈部切除 ,不需做胸骨切开。晚期恶性肿瘤 ,姑息切除后辅以放、化疗 ,仍可取得较好疗效。

ObjectiveTo study the diagnosis and surgical treatment of substernal goiter(SG). MethodsA retrospective analysis was made on 34 cases of substernal goiter surgically treated in our department from 1982 to 1998. The preoperative exmination?surgical modality and the postoperative complications were reviewed. Resules The incidence of SG was 4%(34/920) with male to female rate of 1∶2.8 . The malignant rate was 15%(5/34). Preoperative radiograph demonstrated tracheal deviation in 7 cases (21%), esophageal compression in 6 cases(18%); CT?MRI examination showed major vessel deviation in 3 cases(9%). The diagnosis rate of radiograph and CT was 82% and 94%, respectively. Conclusion Substernal goiter can be resected by transcervical incision without the need of sternotomy. In cases of advanced carcinoma beyond any possibility of radical resection, palliative resection plus postoperative chemotherapy or/and radiotherapy may achieve as well satisfactory long-term survival.