Agarwal Amit, Mishra Anand K, Gupta Sushil K, Arshad Farah, Agarwal Anil, Tripathi M, Singh P K
Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, 226 014 Lucknow, India.
World J Surg. 2007 Apr;31(4):832-7. doi: 10.1007/s00268-006-0565-8.
Our institute caters to a large number of patients with large, longstanding multinodular goiters; tracheal deviation and resulting airway problems like tracheomalacia are relatively common. However, the literature is sparse on the criteria of early diagnosis and optimum management of tracheomalacia, which our study highlights.
This retrospective study analyzed 900 thyroidectomies carried out during 1990-2005 for which data from 28 patients treated for tracheomalacia after thyroidectomy were available for analysis. Criteria for making a diagnosis of tracheomalacia after thyroidectomy included one or more of the following: normal vocal cord mobility, absence of glottic or subglottic edema or hematoma, soft and floppy trachea on palpation, obstruction to spontaneous respiration on gradual withdrawal of the endotracheal tube.
Mean duration of thyroid enlargement was 13.75 years. Only 7 patients had a history of stridor. Tracheostomy was performed in 26 patients, and 2 patients were put on prolonged intubation. Tracheostomy was performed in 18 patients on the operating table, and 8 in the recovery room. The mean weight of the gland was 442 g and histopathology revealed that 11 cases were benign goiter. The tracheostomy tube was removed after an average of 8.5 days. There were no cases of tracheal stenosis on long-term follow-up.
Patients with longstanding goiter, even when benign, are more prone to develop tracheomalacia. On the basis of our experience we strongly advocate tracheostomy intraoperatively if the trachea is soft and floppy and/or collapse of the trachea is observed following gradual withdrawal of the endotracheal tube.
我们的研究所接待了大量患有巨大、长期存在的多结节性甲状腺肿的患者；气管偏移以及由此导致的气道问题如气管软化相对常见。然而，关于气管软化的早期诊断标准和最佳治疗方法的文献较少，我们的研究突出了这一点。
这项回顾性研究分析了1990年至2005年间进行的900例甲状腺切除术，其中有28例甲状腺切除术后接受气管软化治疗的患者的数据可供分析。甲状腺切除术后气管软化的诊断标准包括以下一项或多项：声带活动正常、无声门或声门下水肿或血肿、触诊时气管柔软且松弛、在逐渐拔出气管内导管时对自主呼吸有阻碍。
甲状腺肿大的平均持续时间为13.75年。只有7例患者有喘鸣病史。26例患者进行了气管切开术，2例患者进行了长时间插管。18例患者在手术台上进行了气管切开术，8例在恢复室进行。腺体的平均重量为442克，组织病理学显示11例为良性甲状腺肿。气管切开管平均在8.5天后拔除。长期随访中无气管狭窄病例。
患有长期甲状腺肿的患者，即使是良性的，也更容易发生气管软化。根据我们的经验，如果气管柔软且松弛和/或在逐渐拔出气管内导管后观察到气管塌陷，我们强烈主张在术中进行气管切开术。
