Retrosternal goiter is an enlarged thyroid mass of which more than 50% is located in the mediastinum. Indications for surgery of retrosternal goiter include ineffective pharmacological treatment, mechanical syndrome, suspicion of malignancy and thyrotoxicosis. Computed tomography is the gold standard in the diagnosis of retrosternal goiter. The surgery can be performed from a cervical incision, using sternotomy or thoracotomy.
The aim of our study was to evaluate our own group of retrosternal goiters. In 2011-2019, 1739 thyroid surgeries were performed at the 3rd Department of Surgery, University Hospital Motol, Prague. We retrospectively followed the age, gender, retrosternal spreading, postoperative complications (especially hypocalcemia, bleeding and dysphonia) and the definitive histological finding.
Retrosternal goiters were presented in 202 (19.2%) of the total of 1739 thyroid surgery patients. Sternotomy was performed in 31 patients. Women (61%) predominated over men (39%). The mean operating time was 125 minutes. We did not detect any serious postoperative bleeding necessitating surgical revision. Temporary hypocalcemia was observed in 10 patients (32%) based on laboratory testing. Unilateral iatrogenic vocal cord paresis was observed in 6 patients (19.4%) and was permanent in 3 patients (9.3%). One patient passed away soon after the operation, nevertheless the death was related to a simultaneously planned cardiothoracic procedure.
The retrosternal goiter can be removed using the cervical approach in most cases. Total thyroidectomy using sternotomy is associated with higher morbidity and mortality, higher blood loss and longer hospital stay; nevertheless, it does not increase the risk of long-term postoperative complications. Procedures requiring sternotomy or thoracotomy should be done at centers experienced in these types of procedures.
胸骨后甲状腺肿是一种甲状腺肿大的疾病，其中超过 50%的甲状腺肿位于纵隔内。胸骨后甲状腺肿手术的适应证包括药物治疗无效、机械综合征、怀疑恶性肿瘤和甲状腺毒症。计算机断层扫描是诊断胸骨后甲状腺肿的金标准。手术可通过颈部切口、胸骨切开术或开胸术进行。
我们的研究目的是评估我们自己的胸骨后甲状腺肿患者群体。2011 年至 2019 年，布拉格第三外科大学附属医院共进行了 1739 例甲状腺手术。我们回顾性随访了年龄、性别、胸骨后扩散、术后并发症（特别是低钙血症、出血和声音嘶哑）和最终的组织学发现。
在总共 1739 例甲状腺手术患者中，有 202 例（19.2%）患有胸骨后甲状腺肿。31 例患者接受了胸骨切开术。女性（61%）多于男性（39%）。平均手术时间为 125 分钟。我们没有发现任何需要手术修正的严重术后出血。根据实验室检查，10 例患者（32%）出现暂时性低钙血症。6 例患者（19.4%）出现单侧医源性声带麻痹，3 例患者（9.3%）永久性声带麻痹。1 例患者术后不久死亡，但死亡与同时计划进行的心胸外科手术有关。
在大多数情况下，胸骨后甲状腺肿可以通过颈部入路切除。使用胸骨切开术的全甲状腺切除术与更高的发病率和死亡率、更高的出血量和更长的住院时间相关；然而，它不会增加长期术后并发症的风险。需要进行胸骨切开术或开胸术的手术应在有经验的中心进行。
