Vaiman Michael, Bekerman Inessa
Department of Otorhinolaryngology Head and Neck Surgery, Assaf HaRofeh Medical Center, Affiliated To the Sackler Faculty of Medicine, Tel Aviv University, 33 Shapira Street, 59561, Bat Yam, Israel.
Department of Radiology, Assaf HaRofeh Medical Center, Affiliated To the Sackler Faculty of Medicine, Tel Aviv University, Bat Yam, Israel.
Eur Arch Otorhinolaryngol. 2017 Feb;274(2):1029-1034. doi: 10.1007/s00405-016-4322-9. Epub 2016 Sep 29.
The anatomical approach to the intrathoracic goiter (ITG) was used to understand its etiology and to rationalize surgical technique of thyroidectomy. For a retrospective chart review, we selected cases of multinodular goiter with totally ITGs (n = 69; M 29, F 40), while 916 cases with cervical goiter were used for comparison. The topography of the thyroid gland was assessed against the tracheal rings and against the vertebrae. The regional anatomy of the thoracic inlet was assessed by its bony margins and the relations of structures traversing the area. Average tracheal-diameter-to-thoracic-inlet ratio was calculated. The ITG group consisted of 52 cases of retrosternal goiter (75.4 %), nine cases of retrotracheal goiter (13 %), and eight cases of retroesophageal goiter (11.6 %). In all but one analyzed cases, the goiters were removed via cervical incision. Mean weight of goiters was 183 g. The area of thoracic inlet in the cases of ITG had no difference in comparison with the cases of cervical goiter (F/M p = 0.11/0.15), but the tracheal-diameter-to-thoracic-inlet ratio was significantly smaller (F/M p = 0.06/0.04). In the ITG cases, the position of the upper edge of the isthmus of the thyroid was about 1.5 tracheal rings lower than in healthy individuals (p = 0.03). The area of the thoracic inlet, the neck size, and the anteroposterior diameter of the inlet do not affect the development of the ITG. The smaller tracheal-diameter-to-thoracic-inlet ratio and the lower position of the thyroid gland are the main indicators for the development of the ITG.
采用解剖学方法研究胸内甲状腺肿（ITG），以了解其病因并使甲状腺切除术的手术技术更合理。为进行回顾性病历审查，我们选择了完全为胸内甲状腺肿的多结节性甲状腺肿病例（n = 69；男性29例，女性40例），同时选取916例颈部甲状腺肿病例作为对照。根据气管环和椎体评估甲状腺的位置。通过胸廓入口的骨性边缘及其内部结构的关系评估胸廓入口的局部解剖结构。计算气管直径与胸廓入口的平均比值。ITG组包括52例胸骨后甲状腺肿（75.4%）、9例气管后甲状腺肿（13%）和8例食管后甲状腺肿（11.6%）。除1例分析病例外，其余病例均通过颈部切口切除甲状腺肿。甲状腺肿的平均重量为183 g。ITG病例的胸廓入口面积与颈部甲状腺肿病例相比无差异（男性/女性p = 0.11/0.15），但气管直径与胸廓入口的比值明显更小（男性/女性p = 0.06/0.04）。在ITG病例中，甲状腺峡部上缘的位置比健康个体低约1.5个气管环（p = 0.03）。胸廓入口面积、颈部大小和入口的前后径不影响ITG的发生。气管直径与胸廓入口比值较小以及甲状腺位置较低是ITG发生的主要指标。
