Servicio de Cirugía General y del Aparato Digestivo I, Servicio de Endocrinologia y Nutrición, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
Surgery. 2010 Feb;147(2):233-8. doi: 10.1016/j.surg.2009.06.018.
Intrathoracic goiter (IG) is a pathologic and clinical entity defined by criteria that varies from one series to the next. The objective of this study was to determine the most useful definition of IG for predicting intra-operative and postoperative complications.
The study included 201 patients treated for multinodular goiter who met the following criteria: (1) they had no previous thyroid surgery; (2) they had undergone total thyroidectomy; and (3) they were diagnosed with IG according to 1 of the following definitions: (1) clinical; (2) Hsu's; (3) Kocher's; (4) Torre's; (5) Eschapase's; (6) Lahey's; (7) Lindskog's; (8) Crile's; (9) Katlic's; and (10) subcarinal. Three variables were evaluated: (1) intra-operative complications; (2) need for a sternotomy; and (3) postoperative complications.
During orotracheal intubation, there were difficulties in 25 cases, all of which were detected using the 6 least restrictive definitions of IG (these range from the clinical definition to Lahey's definition. In 6 (3%) cases, it was necessary to carry out a sternotomy. The thoracic approach could be predicted using Katlic's definition. None of the definitions of IG was useful for predicting postoperative complications.
Most definitions of IG can be ignored because they are not clinically relevant. The 6 least restrictive definitions overlap in their utility to predict intubation difficult during the anesthetic process; consequently, the clinical definition should be used because it is the simplest to calculate. Katlic's definition is the most useful for predicting a possible sternotomy for extirpating goiter.
胸腔内甲状腺肿（IG）是一种病理和临床实体，其定义标准因一系列因素而异。本研究的目的是确定最有用的 IG 定义，以预测术中及术后并发症。
该研究纳入了 201 例接受多结节性甲状腺肿治疗的患者，这些患者符合以下标准：（1）无既往甲状腺手术史；（2）行全甲状腺切除术；（3）根据以下 10 种定义中的 1 种诊断为 IG：（1）临床；（2）Hsu's；（3）Kocher's；（4）Torre's；（5）Eschapase's；（6）Lahey's；（7）Lindskog's；（8）Crile's；（9）Katlic's；（10）隆突下。评估了 3 个变量：（1）术中并发症；（2）需要行胸骨切开术；（3）术后并发症。
在经口气管插管过程中，有 25 例出现困难，所有这些都使用 IG 的 6 种限制最少的定义（从临床定义到 Lahey's 定义）检测到。在 6（3%）例中，需要进行胸骨切开术。Katlic's 定义可预测胸腔入路。IG 的任何定义都不能预测术后并发症。
大多数 IG 定义可以忽略，因为它们与临床无关。6 种限制最少的定义在预测麻醉过程中插管困难方面具有重叠性；因此，应使用临床定义，因为它计算最简单。Katlic's 定义最有助于预测切除甲状腺肿时可能需要行胸骨切开术。
