Wu Yue-Huang, Qi Yong-Fa, Tang Ping-Zhang, Xu Zhen-Gang
Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical University, Beijing 100021, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2006 Jul;41(7):528-31.
To explore the Surgical approach and management of intrathoracic goiter.
Seventy patients were operated on for thyromegaly extending to the thorax in an 15-year period at the department of Head and Neck surgery, Cancer Hospital, Chinese Academy of Medical Sciences. The median age of the 70 patients (44 women and 26 men) was 55 years, with a range of 23 to 71 years. Sixty cases were benign intrathoracic goiter and ten cases were malignancy. To help choice of operative approach, the intrathoracic goiter was divided into three types to based on chest film, computed tomography or magnetic resonance imaging and clinical symptom. I type: the inferior extremity of goiter is on the aortic arch. II type is the goiter to enter intrathoracic and portion located behind aortic arch, or the goiter enter posterior mediastinum. For III type, intrathoracic goiter intrude thoracic cavity, or accompany superior vena caval syndrome. Operative method, surgical access and treatment effect were discussed in this essay.
A cervical incision alone was performed in 62 cases (I type 41 cases, II type 21 cases), and sternotomy in 8 (II type 3 cases, III type 5 cases). There was low morbidity and no deaths. Removal rate by cervical approach for intrathoracic benign and malignant goiter were 95% (57/60) and 50% (5/10) respectively. The Complication rate of cervical approach was significantly lower (8.1%) than that sternotomy approach (37.5%, P < 0.01).
Most cases of intrathoracic goiter can be managed by cervical incision alone. Only a few cases, a median sternotomy approach may be needed when adhesions or an anomalous blood supply are present or carcinoma is suspected.
探讨胸内甲状腺肿的手术方法及处理。
中国医学科学院肿瘤医院头颈外科在15年期间对70例甲状腺肿大延伸至胸部的患者进行了手术。这70例患者（44例女性和26例男性）的中位年龄为55岁，年龄范围为23至71岁。60例为良性胸内甲状腺肿，10例为恶性。为了帮助选择手术方式，根据胸部X线片、计算机断层扫描或磁共振成像以及临床症状将胸内甲状腺肿分为三种类型。I型：甲状腺下端位于主动脉弓上。II型是甲状腺进入胸腔且部分位于主动脉弓后方，或甲状腺进入后纵隔。III型为胸内甲状腺肿侵入胸腔，或伴有上腔静脉综合征。本文讨论了手术方法、手术入路及治疗效果。
62例（I型41例，II型21例）仅行颈部切口，8例（II型3例，III型5例）行胸骨正中切开术。发病率低，无死亡病例。胸内良性和恶性甲状腺肿经颈部入路的切除率分别为95%（57/60）和50%（5/10）。颈部入路的并发症发生率显著低于胸骨正中切开术入路（8.1%比37.5%，P<0.01）。
大多数胸内甲状腺肿病例可仅通过颈部切口处理。仅少数病例，当存在粘连或异常血供或怀疑有癌变时，可能需要采用胸骨正中切开术入路。
