Aydin Ismail, Sengul Ilker, Sengul Demet
General Surgery, Giresun University Faculty of Medicine, Giresun, TUR.
Endocrine Surgery, General Surgery, Giresun University Faculty of Medicine, Giresun, TUR.
Cureus. 2021 Jan 15;13(1):e12720. doi: 10.7759/cureus.12720.
Substernal goiter is an enlarged thyroid gland, harboring a component extending into the mediastinum. Surgical management requires genuine and rigorous preoperative planning as physicians could encounter the prospect of the gland coming into close quarters with the vital intrathoracic structures. The neck and chest multiplanar cross-sectional imaging provide essentialness of an extracervical approach for the procedure. In the present study, a 57-year-old female who admitted with the intermittent dyspnea and dysphagia with a huge goiter is reported. The labs were reported within the normal limits and the video laryngoscopy displayed no pathologic finding. Her neck sonography revealed the multiple nodules within the gland, without determining the most proximal border of the left lobe. The neck and chest computed tomography depicted a substernal goiter harboring the left lobe, extending till the left innominate vein and a sutureless total thyroidectomy by the collar incision without a median sternotomy was performed. We would recommend sutureless thyroidectomy for substernal goiter just considering to divide meticulously the superior thyroid arteries and veins separately and exploring the fibrous Ligament of Berry, that is, the true Ligament of Berry, with its safe relationship to the recurrent laryngeal nerve in Thyroidology.
胸骨后甲状腺肿是甲状腺肿大，其一部分延伸至纵隔。手术治疗需要认真且严谨的术前规划，因为医生可能会面临甲状腺与胸腔内重要结构紧密相邻的情况。颈部和胸部的多平面横断面成像显示了该手术采用颈外入路的必要性。在本研究中，报告了一名57岁女性，因巨大甲状腺肿伴间歇性呼吸困难和吞咽困难入院。实验室检查结果在正常范围内，视频喉镜检查未发现病理改变。她的颈部超声显示甲状腺内有多个结节，未确定左叶的最近端边界。颈部和胸部计算机断层扫描显示胸骨后甲状腺肿累及左叶，延伸至左无名静脉，遂通过领口切口行无正中胸骨切开的无缝合全甲状腺切除术。考虑到在甲状腺学中需分别仔细分离甲状腺上动静脉并探查Berry韧带（即真正的Berry韧带）及其与喉返神经的安全关系，我们推荐对胸骨后甲状腺肿行无缝合甲状腺切除术。
