Gao Bo, Jiang Yan, Zhang Xiaohua, Zhao Jianjie, He Yujun, Wen Yayuan, Zhang Shu, Luo Donglin
Department of Surgery for Breast and Thyroid, Institute of Surgery Research, Daping Hospital, Third Military Medical University Chongqing 400042, China.
Int J Clin Exp Med. 2013 Aug 1;6(7):488-96. Print 2013.
This study was carried out to evaluate the clinical presentation, surgical treatment, complications, and risk of malignancy for large substernal goiter. From March 2010 to December 2012, 12 patients with large substernal thyroid goiter who underwent surgery in our Department were enrolled in the study. Their medical records were retrospectively analyzed. Collar-shaped incision was adequate for resection of the lesions in 10 (83%) patients, while two (17%) patients required combined cervical-thoracic incision. In addition, one case was subjected to postoperative tracheotomy. Transient hypocalcaemia occurred in one case. The incidence of transient hoarseness, tracheomalacia and hypothyroidism was 8.3%. There was no perioperative bleeding, thyroid storm as well as other serious complications. All patients were clinically cured. Therefore, cervical collar incision is nearly always adequate for most cases of larger substernal goiter, and sternotomy can be avoided. Furthermore, the application of intraoperative ultrasonic knife can effectively reduce intraoperative and postoperative complications. Aggressive perioperative management is crucial for the successful removal of large substernal goiter.
本研究旨在评估巨大胸骨后甲状腺肿的临床表现、手术治疗、并发症及恶变风险。2010年3月至2012年12月，纳入我科12例行手术治疗的巨大胸骨后甲状腺肿患者。对其病历进行回顾性分析。10例（83%）患者采用领口状切口即可充分切除病变，2例（17%）患者需行颈胸联合切口。此外，1例患者术后行气管切开术。1例发生短暂性低钙血症。短暂性声音嘶哑、气管软化及甲状腺功能减退的发生率为8.3%。无围手术期出血、甲状腺危象及其他严重并发症。所有患者均临床治愈。因此，对于大多数巨大胸骨后甲状腺肿病例，颈部领口状切口几乎总是足够的，可避免胸骨切开术。此外，术中应用超声刀可有效减少术中及术后并发症。积极的围手术期管理对成功切除巨大胸骨后甲状腺肿至关重要。
