Kadhim A L, Sheahan P, Timon C
Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Trinity College, Dublin, Ireland.
J Laryngol Otol. 2006 Dec;120(12):1038-41. doi: 10.1017/S0022215106003045. Epub 2006 Sep 25.
Goitre presenting with acute, life-threatening airway compromise is an uncommon indication for thyroid surgery. The management of this critical condition is controversial.
To investigate the incidence of life-threatening airway compromise in patients with benign goitre, to investigate the predisposing factors, and to outline an optimal management policy for such critical cases.
Retrospective review of the medical records of patients presenting with life-threatening, acute airway compromise secondary to benign thyroid disease, treated by the senior author (CT) between July 1994 and July 2005.
Of a total of 505 thyroid surgery procedures over the 11-year period, five patients with benign thyroid disease had presented with life-threatening, acute airway compromise. Three of the five patients had been thyrotoxic and two of these had received an iodine load prior to airway compromise. Immediate endotracheal intubation for airway control followed by admission to the intensive care unit had been the presentation in two patients. An incidental diagnosis of tracheal compression had been made from the computed tomography (CT) scan in two patients who had non-resolved obstructive airway disease. Emergency thyroidectomy had been performed in all five patients. Significant tracheomalacia had been noted in four patients. Following thyroidectomy, two patients had required tracheostomy and one had required tracheal stenting.
Chronic obstructive airways disease, substernal extension and long-standing goitre are considered as risk factors for developing acute, life-threatening airway compromise in the presence of benign thyroid disease. A recent iodine load may lead to airway compromise in thyrotoxic patients. A CT scan is indicated in cases of unresponsive chronic obstructive airways disease to rule out substernal extension of non-palpable goitres. Life-threatening airway compromise secondary to benign goitres is best treated by endotracheal intubation if conservative measures fail, followed by emergency thyroidectomy. Following surgery, close observation is mandatory to exclude airway compromise due to tracheomalacia and laryngeal oedema.
甲状腺肿伴发急性、危及生命的气道受压是甲状腺手术的罕见指征。这种危急情况的处理存在争议。
调查良性甲状腺肿患者中危及生命的气道受压发生率，研究其诱发因素，并概述此类危急病例的最佳处理策略。
回顾性分析1994年7月至2005年7月间由资深作者（CT）治疗的因良性甲状腺疾病继发危及生命的急性气道受压患者的病历。
在这11年期间总共进行的505例甲状腺手术中，5例良性甲状腺疾病患者出现了危及生命的急性气道受压。5例患者中有3例为甲状腺毒症，其中2例在气道受压前接受过碘负荷。2例患者的表现为立即行气管插管以控制气道，随后收入重症监护病房。2例患有未缓解的阻塞性气道疾病的患者通过计算机断层扫描（CT）偶然诊断出气管受压。所有5例患者均接受了急诊甲状腺切除术。4例患者发现有明显的气管软化。甲状腺切除术后，2例患者需要气管造口术，1例患者需要气管支架置入术。
慢性阻塞性气道疾病、胸骨后延伸和长期存在的甲状腺肿被认为是良性甲状腺疾病患者发生急性、危及生命的气道受压的危险因素。近期的碘负荷可能导致甲状腺毒症患者气道受压。对于慢性阻塞性气道疾病无反应的病例，建议进行CT扫描以排除不可触及的甲状腺肿的胸骨后延伸。如果保守措施失败，良性甲状腺肿继发的危及生命的气道受压最好通过气管插管治疗，随后进行急诊甲状腺切除术。手术后，必须密切观察以排除因气管软化和喉水肿导致的气道受压。
