Cougard P, Matet P, Goudet P, Bambili R, Viard H, Vaillant G, Vergès B, Brun J M
Clinique Chirurgicale, Hôpital du Bocage, Dijon.
Ann Endocrinol (Paris). 1992;53(5-6):230-5.
The authors are presenting a retrospective study on 218 retrosternal goiters operated between 1968 and 1991. 33% of the goiters were incidentally discovered on a plain X-ray of the chest. Symptoms of compression were present in 50.5% of patients and hyperthyroidism in 16.5%. Respiratory manifestations were more frequent and more severe in patients aged 70 and more. Moreover 90% of those old patients were symptomatic. Goiters migrated anteriorly in 57.7% of cases, posteriorly in 33.9%, both anteriorly and posteriorly in 5.5%. Type of migration was unknown in 2.5%. 3.7% were malignant. 27 patients with respiratory symptoms received corticosteroids to reduce the airway compression. Among 52 patients with hyperthyroidism, 36 were given antithyroid drugs. Among them, some received corticosteroid drugs in order to reduce risks of mediastinal compression. A simple cervicotomy was adequate in 92.7% of case and was completed by sternotomy in 7.3%. The operation was iterative for relapsing or forgotten thoracic goiters in 24 cases. Morbidity was slight even for sternotomized patients. Mortality was noted in 2 cases (0.9%) one of them operated on for poorly-differentiated and suffocating carcinoma of the thyroid. We advise a straightforward surgical attitude as a result of the slight morbidity and mortality, even in sternotomized patients in order to avoid severe compressive complications of the airways.
作者对1968年至1991年间接受手术的218例胸骨后甲状腺肿进行了一项回顾性研究。33%的甲状腺肿是在胸部X线平片检查时偶然发现的。50.5%的患者有压迫症状，16.5%的患者有甲状腺功能亢进。70岁及以上患者的呼吸系统表现更为频繁和严重。此外，这些老年患者中有90%有症状。57.7%的病例中甲状腺肿向前移位，33.9%向后移位，5.5%向前和向后移位。2.5%的病例移位类型不明。3.7%为恶性。27例有呼吸道症状的患者接受了皮质类固醇治疗以减轻气道压迫。在52例甲状腺功能亢进患者中，36例给予了抗甲状腺药物。其中一些患者接受了皮质类固醇药物治疗以降低纵隔压迫的风险。92.7%的病例单纯颈部切开术就足够了，7.3%的病例在颈部切开术后还需胸骨切开术。24例复发性或被遗忘的胸段甲状腺肿患者进行了再次手术。即使是接受胸骨切开术的患者，发病率也较低。2例患者死亡（0.9%），其中1例因甲状腺低分化窒息性癌接受手术。由于发病率和死亡率较低，我们建议采取直接的手术方式，即使是接受胸骨切开术的患者，以避免气道严重压迫并发症。
