Calò Pietro Giorgio, Tatti Alberto, Farris Stefania, Piga Gabriele, Malloci Armando, Nicolosi Angelo
Università degli Studi di Cagliari, Dipartimento di Chirurgia, Policlinico Universitario Monserrato, U.O. Chirurgia Generale.
Ann Ital Chir. 2005 Jul-Aug;76(4):331-5.
The Authors report on their experience in the surgical treatment of substernal goiter.
Between 1972 and 2004, 222 patients with substernal goiters were observed among 2720 patients undergoing surgical treatment for various thyroid diseases (8.16%). Seventy patients underwent subtotal thyroidectomy and 152 total thyroidectomy. A cervical approach was employed in 213 cases, a sternotomy was required in 7 patients while a thoracotomy was necessary in 2 cases. Postoperative complications were definitive hypoparathyroidism in 9 cases (4%), recurrent laryngeal nerve palsy in 5 patients (2.2%) and postoperative bleeding in 4 cases (1.8%); there was no intraoperative mortality.
In substernal goiter it is necessary to define its exact relationship to neck and mediastinal structures in order to establish the most appropriate surgical approach. In the majority of the cases total thyroidectomy is possible through a cervical approach with an acceptable morbidity rate. When dissection of the substernal goiter is difficult and recurrent laryngeal nerve is not clearly identified, partial sternotomy is required to enable a better control of the nerve and the vessels with only a minimal morbidity rate. Thoracotomy is rarely necessary.
作者报告其胸骨后甲状腺肿手术治疗的经验。
1972年至2004年间，在2720例因各种甲状腺疾病接受手术治疗的患者中观察到222例胸骨后甲状腺肿患者（8.16%）。70例行甲状腺次全切除术，152例行甲状腺全切除术。213例采用颈部入路，7例需要胸骨切开术，2例需要开胸手术。术后并发症包括9例永久性甲状旁腺功能减退（4%）、5例喉返神经麻痹（2.2%）和4例术后出血（1.8%）；无术中死亡。
对于胸骨后甲状腺肿，有必要明确其与颈部和纵隔结构的确切关系，以确定最合适的手术入路。在大多数情况下，通过颈部入路行甲状腺全切除术是可行的，发病率可接受。当胸骨后甲状腺肿的解剖困难且喉返神经无法清晰辨认时，需要部分胸骨切开术以更好地控制神经和血管，发病率极低。开胸手术很少需要。
