Aziret Mehmet, Topçuoğlu Mehmet Şah, Ozçelik Cemal, Ozkaya Muharrem
Adana Numune Training and Research Hospital Department of General Surgery, Adana and Kars State Hospital General Surgery, Turkey.
Çukurova University, Department of Cardiovascular Surgery, Adana, Turkey.
Int J Surg Case Rep. 2014;5(8):465-8. doi: 10.1016/j.ijscr.2014.05.015. Epub 2014 Jun 6.
Surgical treatment of benign thyroid diseases need to be followed up closely, since recurrent thyroid nodules can be seen after subtotal thyroidectomy. Intrathoracic goiter (ITG) occurs in 10-30% of patients following subtotal thyroidectomy. In general these goiters are benign, having a malignant rate of only 2-22%. ITG grows slowly but steadily and in its process of development, it narrows the thoracic inlet by compressing the surrounding structures. Most of these can not located in the anterior mediastinum, others located in posterior retrovascular area. Bilateral posterior retrovascular goiters are very rare.
We report a case involving a 61-year-old woman with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. She had undergone bilateral thyroid lobectomy for a cervical goiter 10 years ago. The mass was removed successfully via median sternotomy without complication. The patient recovered well and was discharged in 1 week.
Most anterior mediastinal goiters can be resected through a transcervical approach, but if those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy.
Bilateral recurrent posterior mediastinal and retrovascular large goiters are better resected via sternotomy rather than lateral thoracotomy. The reason for that are the possibility of injury to large vascular structures and the difficulty of their management through lateral thoracotomy when cardiopulmonary bypass needed.
良性甲状腺疾病的手术治疗需要密切随访，因为甲状腺次全切除术后可见甲状腺结节复发。胸内甲状腺肿（ITG）在甲状腺次全切除术后的患者中发生率为10% - 30%。一般来说，这些甲状腺肿是良性的，恶性率仅为2% - 22%。ITG生长缓慢但稳定，在其发展过程中，会通过压迫周围结构使胸廓入口变窄。其中大多数位于前纵隔，其他位于后血管区域。双侧后血管甲状腺肿非常罕见。
我们报告一例病例，患者为一名61岁女性，有逐渐加重的呼吸困难病史，因评估一个大的纵隔肿块而转诊至我院。她10年前因颈部甲状腺肿接受了双侧甲状腺叶切除术。通过正中胸骨切开术成功切除肿块，无并发症。患者恢复良好，1周后出院。
大多数前纵隔甲状腺肿可通过经颈入路切除，但如果那些延伸至主动脉弓以外进入后纵隔的甲状腺肿，采用胸骨切开术或侧胸壁切开术处理更好。
双侧复发性后纵隔及后血管大甲状腺肿通过胸骨切开术而非侧胸壁切开术切除更好。原因是存在损伤大血管结构的可能性，以及在需要体外循环时通过侧胸壁切开术处理这些血管的困难。
