Parra-Membrives Pablo, Sánchez-Blanco José Miguel, Gómez-Rubio Diego, Recio-Moyano Gumersindo, Diaz-Roldán Jorge
Department of General and Digestive Surgery, Hospital Universitario de Valme, Sevilla, Spain.
Int Surg. 2003 Oct-Dec;88(4):205-10.
Retrosternal goiters still pose a problem to expert endocrine surgeons. Whether surgery should be the treatment of choice or not remains controversial because of hypothetical increased morbidity rates associated with the surgical approach. Eighty-three patients were retrospectively reviewed for anesthetic risk, fibrobronchoscopic guidance for intubation, surgical technique, mortality and morbidity rates, and pathological findings. We found 6.09% of American Society of Anesthesiologists (ASA) I, 41.46% of ASA II, 40.24% of ASA III, and 12.19% of ASA IV risk. Twelve patients (14.45%) required fibrobronchoscopic guidance for intubation. Only one patient required a sternotomy. No mortality occurred. Seven patients (8.43%) had major complications, but there were no instances of permanent recurrent laryngeal palsy or hypocalcemia. Pathological examination revealed 9.63% incidence of malignancy. Surgery should be the treatment of choice for retrosternal goiters because there is a significant incidence of malignancy and an acceptable morbidity rate.
胸骨后甲状腺肿仍然给专业内分泌外科医生带来难题。由于手术方式可能导致发病率增加，手术是否应作为首选治疗方法仍存在争议。回顾性分析了83例患者的麻醉风险、纤维支气管镜引导插管、手术技术、死亡率和发病率以及病理结果。我们发现美国麻醉医师协会（ASA）I级风险的患者占6.09%，ASA II级风险的占41.46%，ASA III级风险的占40.24%，ASA IV级风险的占12.19%。12例患者（14.45%）需要纤维支气管镜引导插管。仅1例患者需要进行胸骨切开术。无死亡病例。7例患者（8.43%）发生了严重并发症，但无永久性喉返神经麻痹或低钙血症病例。病理检查显示恶性肿瘤发生率为9.63%。由于胸骨后甲状腺肿有显著的恶性肿瘤发生率且发病率可接受，手术应作为其首选治疗方法。
