de Perrot M, Fadel E, Mercier O, Farhamand P, Fabre D, Mussot S, Dartevelle P
Department of Thoracic and Vascular Surgery, Hospital Marie-Lannelongue, University Paris-Sud, Le Plessis-Robinson, France.
Thorac Cardiovasc Surg. 2007 Feb;55(1):39-43. doi: 10.1055/s-2006-924440.
Mediastinal goiters are frequently diagnosed, particularly in the elderly population. However, factors associated with an increased risk of median sternotomy have not been analyzed systematically.
Between 1980 and 2004, a total of 185 patients underwent surgery for mediastinal goiters in our institution. There were 126 women and 59 men with a median age of 68 years (range 24 to 94 years). The goiters were left-sided in 77 patients, right-sided in 69 patients, and bilateral in 39 patients.
Clinical presentation was mainly dyspnea (37 %), palpation of a cervical mass (35 %), superior vena cava syndrome (5 %), dysphagia (4 %) and dysphonia (4 %). Goiters measured between 5 and 23 cm (median 10 cm) and were prevascular (38 %), retrovascular and paratracheal (33 %), and retrotracheal (27 %). Aberrant intrathoracic goiters were observed in 4 patients (2 %). The large majority of goiters could be removed transcervically, regardless of the location and extension of the goiters. A sternotomy was required in 13 patients (6 %), mainly because of recurrent goiter ( P = 0.1), ectopic goiter ( P < 0.001), or invasive carcinoma ( P < 0.001). Superior vena cava syndrome, emergent airway compression, dysphagia, retrotracheal goiter, or crossover goiters were not found to be associated with an increased risk of sternotomy. One patient (0.5 %) died postoperatively from massive intraoperative carcinomatous pulmonary emboli. Histology demonstrated a thyroid carcinoma in 18 patients (10 %).
Surgery for mediastinal goiters should always be considered, even in elderly patients because of the high risk of tracheal compression and the low morbidity of the surgery. Most mediastinal goiters are benign and can be removed through a cervical approach. Sternotomy should only be performed in cases of previous cervical thyroidectomy, invasive carcinoma, or ectopic goiter.
纵隔甲状腺肿常被诊断出来，尤其是在老年人群中。然而，与正中胸骨切开术风险增加相关的因素尚未得到系统分析。
1980年至2004年间，我院共有185例患者接受了纵隔甲状腺肿手术。其中女性126例，男性59例，中位年龄68岁（范围24至94岁）。甲状腺肿位于左侧77例，右侧69例，双侧39例。
临床表现主要为呼吸困难（37%）、可触及颈部肿块（35%）、上腔静脉综合征（5%）、吞咽困难（4%）和声音嘶哑（4%）。甲状腺肿大小在5至23厘米之间（中位值10厘米），位于血管前（38%）、血管后和气管旁（33%）以及气管后（27%）。4例患者（2%）观察到异位胸内甲状腺肿。绝大多数甲状腺肿可经颈部切除，无论其位置和范围如何。13例患者（6%）需要进行胸骨切开术，主要原因是复发性甲状腺肿（P = 0.1）、异位甲状腺肿（P < 0.001）或浸润性癌（P < 0.001）。未发现上腔静脉综合征、紧急气道压迫、吞咽困难、气管后甲状腺肿或交叉甲状腺肿与胸骨切开术风险增加相关。1例患者（0.5%）术后死于术中大量癌性肺栓塞。组织学检查显示18例患者（10%）患有甲状腺癌。
即使是老年患者，由于气管受压风险高且手术发病率低，纵隔甲状腺肿的手术治疗也应始终予以考虑。大多数纵隔甲状腺肿是良性的，可通过颈部入路切除。仅在先前进行过颈部甲状腺切除术、浸润性癌或异位甲状腺肿的情况下才应进行胸骨切开术。
