Başoğlu Mahmut, Öztürk Gürkan, Aydınlı Bülent, Yıldırgan M İlhan, Atamanalp S Selçuk, Celebi Fehmi
Ataturk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey.
Eurasian J Med. 2009 Aug;41(2):75-9.
Benign nodular goiter (BNG) can cause narrowing of the upper airway. In some rare cases, obstruction of the upper airway also occurs. The following paper reports our experiences with regard to BNG patients who experienced obstruction of the upper airway.
We retrospectively investigated the records of 13 patients with acute airway obstruction due to BNG who were admitted to the General Surgery Department of Ataturk University Medical School between January 2000 and December 2007.
Thirteen patients with airway obstruction secondary to BNG were hospitalized during this period. There were two males and 11 females, and the mean age was 58.5 years (range 37-74 years). For all patients, the primary symptom upon admission was defined as respiratory distress; all patients had varying degrees of respiratory distress upon admission. Three of the patients underwent emergent endotracheal intubation in the emergency room. A preoperative radiological evaluation was performed with thyroid ultrasonography (US) and computed tomography (CT). There were retrosternal or substernal components of the BNG in nine patients. Twelve patients underwent operations, while one patient with mild respiratory distress elected not to be operated on. Ten patients underwent total thyroidectomies, while two patients underwent near-total thyroidectomies. One patient with retrosternal goiter also underwent a median sternotomy. Three patients received a tracheostomy after the operation. Suction drains were utilized in all operations. During the post-operative period, two patients suffered from voice impairment, and seven patients experienced hypocalcemia. Two patients died. Pathological examination of the thyroidectomy tissue revealed BNG in all cases. In addition, two patients had micropapillary carcinomas.
Although BNG causing upper airway obstruction is rare, it is an important clinical entity because of the need for emergent operation, the increased rate of complications, and high mortality.
良性结节性甲状腺肿（BNG）可导致上呼吸道狭窄。在一些罕见病例中，还会发生上呼吸道梗阻。以下论文报告了我们对发生上呼吸道梗阻的BNG患者的治疗经验。
我们回顾性研究了2000年1月至2007年12月期间因BNG导致急性气道梗阻而入住阿塔图尔克大学医学院普通外科的13例患者的病历。
在此期间，13例继发于BNG的气道梗阻患者住院治疗。其中男性2例，女性11例，平均年龄58.5岁（范围37 - 74岁）。所有患者入院时的主要症状均为呼吸窘迫；所有患者入院时均有不同程度的呼吸窘迫。其中3例患者在急诊室接受了紧急气管插管。术前行甲状腺超声（US）和计算机断层扫描（CT）进行影像学评估。9例患者的BNG有胸骨后或胸骨下成分。12例患者接受了手术，而1例轻度呼吸窘迫的患者选择不进行手术。10例患者接受了全甲状腺切除术，2例患者接受了近全甲状腺切除术。1例胸骨后甲状腺肿患者还接受了胸骨正中切开术。3例患者术后接受了气管切开术。所有手术均使用了引流管。术后，2例患者出现声音障碍，7例患者出现低钙血症。2例患者死亡。甲状腺切除组织的病理检查在所有病例中均显示为BNG。此外，2例患者有微小乳头状癌。
尽管导致上呼吸道梗阻的BNG很少见，但由于需要紧急手术、并发症发生率增加和死亡率高，它是一个重要的临床实体。
