Del Rio P, Bezer L, Arcuri M F, Sianesi M
Unit of General Surgery and Organ Transplantation, Department of Surgical Science, School of Medicine, University of Parma, Via Gramsci 14, 43100, Parma, Italy.
Langenbecks Arch Surg. 2009 May;394(3):457-9. doi: 10.1007/s00423-008-0342-2. Epub 2008 May 14.
The thyroid disease can appear in 0.16-3.3% of cases as mediastinal goiter. The treatment is difficult and requires a mediastinal approach.
We have analyzed our experience from September 1995 to September 2007 among 2,439 thyroidectomies conducted for thyroid disease; 16 cases required a sternotomy, in seven patients conducted as hemiclamshell approach (median sternotomy associated to a fourth intercostals space incision). Preoperative evaluation included otorhinolaryngology evaluation and computed tomography. All the cases were followed up to 12 months.
For seven cases treated trough hemiclamshell, the mean age was 57.8 years; hospital stay is 5.2 days. All the patients were discharged after respiratory evaluation; two patients required a pneumological admittance to physio-kinesi-respiratory. There were no cases of hemorrhage, nerve injury, permanent hypocalcemia, and chylothorax. There was no mortality at 30 days.
The hemiclamshell is a safe procedure to treat mediastinal goiter and permit a good exposure of subclavian vessels and mediastinal nodes.
甲状腺疾病患者中纵隔甲状腺肿的发生率为0.16% - 3.3%。其治疗困难，需要采用纵隔入路。
我们分析了1995年9月至2007年9月间因甲状腺疾病行甲状腺切除术的2439例患者的经验；其中16例需要行胸骨切开术，7例采用半蛤壳式入路（正中胸骨切开术联合第四肋间切口）。术前评估包括耳鼻喉科评估和计算机断层扫描。所有病例均随访12个月。
7例行半蛤壳式入路治疗的患者，平均年龄57.8岁；住院时间为5.2天。所有患者经呼吸评估后出院；2例患者需要呼吸康复科收治进行物理 - 运动 - 呼吸治疗。无出血、神经损伤、永久性低钙血症和乳糜胸病例。30天内无死亡病例。
半蛤壳式入路是治疗纵隔甲状腺肿的安全术式，能良好暴露锁骨下血管和纵隔淋巴结。
