Shaha A R, Burnett C, Alfonso A, Jaffe B M
Department of Surgery, Health Science Center, Brooklyn, New York 11203.
Am J Surg. 1989 Oct;158(4):378-80; discussion 380-1. doi: 10.1016/0002-9610(89)90137-2.
Even though thyroid enlargement occurs commonly, the incidence of goiter has decreased in the United States due to the routine use of iodized salt. We continue to see a large number of patients with neglected goiters that cause airway compression. The progressive nature of this disease occasionally results in severe tracheal compression and acute airway distress. We treated 120 patients with airway compression secondary to goiters during a 7-year period. Thirty patients presented initially with acute airway distress requiring either intubation or semiemergent surgery. The decision to operate was based primarily on clinical evaluation and airway films. Ninety patients had substernal goiters. Only one patient required sternal splitting. If one lobe was enlarged causing tracheal deviation, lobectomy was performed; if both lobes were enlarged, subtotal thyroidectomy was performed. Two patients required tracheostomy. There were no operative deaths, and morbidity was limited to minor wound problems. It is important to consider early surgical decompression whenever tracheal compression is caused by goiters, especially if the patients are symptomatic or there is mediastinal extension.
尽管甲状腺肿大很常见，但由于碘盐的常规使用，美国甲状腺肿的发病率已有所下降。我们仍会见到大量因甲状腺肿导致气道受压而被忽视的患者。这种疾病的进展性偶尔会导致严重的气管受压和急性气道窘迫。在7年的时间里，我们治疗了120例因甲状腺肿导致气道受压的患者。30例患者最初表现为急性气道窘迫，需要进行插管或半急诊手术。手术决策主要基于临床评估和气道影像学检查。90例患者患有胸骨后甲状腺肿。仅1例患者需要胸骨劈开术。如果一侧叶肿大导致气管移位，则行叶切除术；如果两侧叶均肿大，则行甲状腺次全切除术。2例患者需要气管切开术。无手术死亡病例，并发症仅限于轻微的伤口问题。当甲状腺肿导致气管受压时，尤其是患者有症状或存在纵隔延伸时，尽早考虑手术减压非常重要。
