Abraham Deepak, Singh Nikhil, Lang Brian, Chan Wai-Fan, Lo Chung-Yau
Department of Surgery, The University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China.
ANZ J Surg. 2007 May;77(5):364-7. doi: 10.1111/j.1445-2197.2007.04061.x.
Although rare in non-endemic areas, benign nodular goitre may cause acute airway obstruction and the clinical management of this condition remains a challenge.
From 1996 to 2005, a total of 1115 patients underwent thyroid surgery at our institution and of these, 7 patients were identified to have a benign nodular goitre leading to acute airway obstruction. They were retrospectively reviewed with reference to the aetiology, presentation, perioperative management and postoperative outcome.
All seven patients were elderly women with a history of symptomatic goitre and concomitant medical problems. Five patients required emergency tracheal intubation, whereas two patients underwent urgent tracheostomy. Total thyroidectomy was successfully carried out for all patients and there was no hospital death. Perioperative complications included three patients with pneumonia, two with renal failure and one with perforated duodenal ulcer. Surgically related complications included transient recurrent nerve palsy in one patient and transient hypocalcaemia in four. After a median follow up of 22 months (range, 4-53 months), two patients died of cerebrovascular accident.
Prompt airway protection followed by total thyroidectomy within the same hospital admission should be recommended and can be associated with favourable outcome.
尽管在非流行地区罕见，但良性结节性甲状腺肿可能导致急性气道梗阻，对此类疾病的临床管理仍然是一项挑战。
1996年至2005年期间，共有1115例患者在我院接受甲状腺手术，其中7例被确诊为良性结节性甲状腺肿并导致急性气道梗阻。对这些患者的病因、临床表现、围手术期管理及术后结果进行回顾性分析。
所有7例患者均为老年女性，有症状性甲状腺肿病史及相关内科疾病。5例患者需要紧急气管插管，2例患者接受了紧急气管切开术。所有患者均成功实施了全甲状腺切除术，无院内死亡。围手术期并发症包括3例肺炎、2例肾衰竭和1例十二指肠溃疡穿孔。手术相关并发症包括1例患者出现短暂性喉返神经麻痹，4例患者出现短暂性低钙血症。中位随访22个月（范围4 - 53个月）后，2例患者死于脑血管意外。
建议在同一住院期间进行及时的气道保护并随后行全甲状腺切除术，这可能会带来良好的结果。
