Batori M, Chatelou E, Straniero A, Mariotta G, Palombi L, Pastore P, Casella G, Casella M C
Department of Surgical Sciences and Applied Medical Technologies, La Sapienza University, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2005 Nov-Dec;9(6):355-9.
Substernal goiter, also said cervico-mediastinic goiter, is a thyroid formation with cervical departure that goes beyond, with stretched neck, the superior thoracic strait for at least 3 cm and that preserves, generally, the parenchimal or fibrous connections between the cervical and thoracic portion, maintaining a direct vascularization supplied by the thyroid arteries. The prevalence of this pathology is very variable and fluctuates between 1.7% and 30% of all thyroid damages. The actual classification is provided by the radiologic examination of the chest and, above all, by the new techniques of imaging.
In the period between January 1998 and December 2003, 332 patients with thyroid pathology have been treated surgically. Forthy-five (13.5%) of these were afflicted with a cervico-mediastinic goiter. In 32/45 (71.1%) cases a total thyroidectomy has been performed by collar carving in accordance with Kocher; in 11/45 (24.5%) cases an hemithyroidectomy has been performed by collar incision; in 2/45 (4.4%) cases, already submitted to surgical intervention of isthmus-lobectomy a totalization has been performed.
The surgical technique foresees always an anterior collar neck incision. This way of access is to prefer in the substernal goiters, both for the presence of a cervical vascularization easy to control and for the possibility, nearly always realizable, to dislocate the goiter by that way. As for what concerns the results of the histological examination, in 2/45 (4.5%) cases it has been set a diagnosis of follicular carcinoma (one of them surely invading and the other, leastly invading), in 3/45 (6.6%) cases papillary carcinoma, in 4/45 (8.8%) cases colloido-cystic goiter, in 33/45 (73.5%) cases micro-macrofollicular hyperplasia (in one of which contemporarily compromise from lymphoma of Hodgkin); in 3/45 (6.6%) cases of adenomatous hyperplasia of the thyroid.
The surgical approach has been in all cases the collar neck incision in accordance to Kocher, and it has never been necessary to associate a sternotomy or thoracotomy. After the intervention, in all the patients the symptomatology tied to the mediastinal compression has disappeared. The goiter showed signs of neoplastic degeneration in 11.1% of the cases, with prevalence of the papillary carcinoma in the 6.6% and, in the remaining 4.5%, of follicular carcinoma. These data are superimposable to the data gathered in other surveys. All the patients passed the post-operating hospitalization in optimal conditions and have been discharged during the fourth post-operating day with the prescription of increasing levothyroxine doses according to the body weigh.
胸骨后甲状腺肿，也称为颈纵隔甲状腺肿，是一种甲状腺组织，其颈部延伸部分超出胸廓上口至少3厘米，颈部伸展时可见，通常保留颈部与胸部部分之间的实质或纤维连接，并由甲状腺动脉维持直接血供。这种病理情况的患病率差异很大，在所有甲状腺疾病中占1.7%至30%。实际分类通过胸部放射学检查，尤其是通过新的成像技术来确定。
在1998年1月至2003年12月期间，332例甲状腺疾病患者接受了手术治疗。其中45例（13.5%）患有颈纵隔甲状腺肿。在45例中的32例（71.1%）中，按照科赫尔方法通过颈部领式切口进行了全甲状腺切除术；在45例中的11例（24.5%）中，通过颈部领式切口进行了甲状腺半切除术；在45例中的2例（4.4%）中，已经接受过峡部-叶切除术的患者进行了全甲状腺切除术。
手术技术始终采用颈部领式前切口。这种入路方式在胸骨后甲状腺肿中更受青睐，这既是因为存在易于控制的颈部血供，也是因为几乎总能通过这种方式将甲状腺肿移位。关于组织学检查结果，在45例中的2例（4.5%）中诊断为滤泡癌（其中1例肯定有侵袭性，另1例侵袭性较小），在45例中的3例（6.6%）中为乳头状癌，在45例中的4例（8.8%）中为胶样囊肿性甲状腺肿，在45例中的33例（73.5%）中为微-大滤泡增生（其中1例同时合并霍奇金淋巴瘤）；在45例中的3例（6.6%）中为甲状腺腺瘤样增生。
所有病例的手术入路均为按照科赫尔方法的颈部领式切口，从未有必要联合胸骨切开术或开胸术。术后，所有患者与纵隔压迫相关的症状均消失。甲状腺肿在11.1%的病例中显示出肿瘤变性迹象，其中乳头状癌占6.6%，其余4.5%为滤泡癌。这些数据与其他调查收集的数据相符。所有患者术后住院情况良好，在术后第四天出院，并根据体重开具了增加左甲状腺素剂量的处方。
