Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital Glasgow UK.
School of Psychological Sciences and Health University of Strathclyde Glasgow UK.
BJS Open. 2018 Dec 26;3(2):174-179. doi: 10.1002/bjs5.50123. eCollection 2019 Apr.
Sternotomy and lateral thoracotomy are required infrequently to remove an intrathoracic goitre (ITG). As few studies have explored the need for an extracervical approach (ECA), the aim of this study was to examine this in a large cohort of patients.
A prospective database of all patients who had surgery for ITG between 2004 and 2016 was interrogated. Patient demographics, preoperative characteristics and type of operation were analysed to identify factors associated with an ECA.
Of 237 patients who had surgery for ITG, 29 (12·2 per cent) required an ECA. ITGs below the aortic arch (odds ratio (OR) 10·84; = 0·004), those with an iceberg shape (OR 59·30; < 0·001) and revisional surgery (OR 4·83; = 0·022) were significant preoperative predictors of an ECA.
The extent of intrathoracic extension in relation to the aortic arch, iceberg goitre shape and revisional surgery were independent risk factors for ECA. Careful preoperative assessment should take these factors into consideration when determining the optimal surgical approach to ITG.
开胸术和侧开胸术很少用于切除胸腔内甲状腺肿（ITG）。由于很少有研究探讨颈外入路（ECA）的必要性，因此本研究旨在对大量患者进行研究。
对 2004 年至 2016 年间因 ITG 接受手术的所有患者的前瞻性数据库进行了查询。分析患者的人口统计学、术前特征和手术类型，以确定与 ECA 相关的因素。
在 237 例因 ITG 接受手术的患者中，有 29 例（12.2%）需要 ECA。主动脉弓以下的甲状腺肿（比值比（OR）10.84； = 0.004）、冰山状甲状腺肿（OR 59.30； < 0.001）和再次手术（OR 4.83； = 0.022）是 ECA 的术前显著预测因素。
与主动脉弓的关系、冰山状甲状腺肿形状和再次手术的胸腔内延伸程度是 ECA 的独立危险因素。在确定 ITG 的最佳手术入路时，应仔细考虑这些因素。
