Machado Norman Oneil, Grant Christopher S, Sharma Ashok Kumar, al Sabti Hilal A, Kolidyan Sreedharan V
Department of Surgery, Sultan Qaboos University Hospital, PO Box 38, Muscat 123, Oman.
Gen Thorac Cardiovasc Surg. 2011 Jul;59(7):507-11. doi: 10.1007/s11748-010-0712-x. Epub 2011 Jul 14.
Most retrosternal goiters are situated in the anterior mediastinal compartment. Posterior mediastinal goiters are uncommon, comprising 10%-15% of all mediastinal goiters. Although most of the anterior mediastinal goiters can be removed by a transcervical approach, posterior mediastinal goiters may require additional extracervical incisions. We report the case of a large posterior mediastinal goiter extending retrotracheally beyond the aortic arch and azygous vein with crossover from the left to the right side. It was excised using a transcervical and right thoracotomy approach. The literature is reviewed to clarify the management of retrosternal goiters with regard to the various approaches, indications for extracervical incisions, and their complications. In conclusion, whereas most retrosternal goiters can be resected through a transcervical approach, those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy. The overall number of complications associated with this approach, however, is higher than that seen with the transcervical approach.
大多数胸骨后甲状腺肿位于前纵隔。后纵隔甲状腺肿并不常见，占所有纵隔甲状腺肿的10% - 15%。尽管大多数前纵隔甲状腺肿可通过经颈入路切除，但后纵隔甲状腺肿可能需要额外的颈外切口。我们报告一例巨大的后纵隔甲状腺肿，其经气管后方延伸至主动脉弓和奇静脉之外，并从左侧交叉至右侧。采用经颈和右胸切开术将其切除。回顾文献以阐明胸骨后甲状腺肿在各种手术入路、颈外切口指征及其并发症方面的处理方法。总之，虽然大多数胸骨后甲状腺肿可通过经颈入路切除，但那些延伸至主动脉弓之外进入后纵隔的甲状腺肿，采用胸骨切开术或侧胸切开术处理更佳。然而，与这种手术入路相关的并发症总数高于经颈入路。
