Haciyanli Selda Gucek, Karaisli Serkan, Acar Nihan, Eygi Bortecin, Haciyanli Mehmet
Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
Sisli Etfal Hastan Tıp Bul. 2021 Sep 24;55(3):318-324. doi: 10.14744/SEMB.2021.76401. eCollection 2021.
Although cervical incisions are usually sufficient in mediastinal located thyroid and parathyroid pathologies, sometimes mediastinal approaches are required. In recent years, less invasive methods have been used instead of median sternotomy. In this study, the adequacy of the incision and morbidity in patients who underwent split sternotomy due to retrosternal goiter (RG) and mediastinal parathyroid pathology in our clinic were investigated.
The files of patients who underwent split sternotomy in addition to cervical incision or split sternotomy extending from the sternal notch to the third intercostal space with a separate vertical incision due to retrosternal thyroid pathology or mediastinal ectopic parathyroid adenoma between January 2010 and January 2021 were retrospectively reviewed. Operative success, exposure provided by split sternotomy, and complication rates were investigated.
Twelve patients who underwent split sternotomy were included in the study. The mean age of the patients was 57.25±12.62 (44-83) years. Eight (66.7%) of the patients were female and 4 (33.3%) were male. The indication for surgery was multinodular goiter (MNG) in 3 (25%) patients, recurrent MNG in 3 (25%) patients, hyperparathyroidism in 3 (25%) patients, and thyroid cancer in 3 (25%) patients. Transient hypocalcemia in 6 (50%) patients and unilateral vocal cord paralysis in 1 (8.3%) patient developed postoperatively, and all complications resolved spontaneously in an average of 3 weeks. Median sternotomy was not required for any of the patients.
Split sternotomy is an adequate and applicable method for the success of the surgery in RG and mediastinal parathyroid pathologies that cannot be excised with the cervical approach.
尽管颈部切口通常足以处理位于纵隔的甲状腺和甲状旁腺病变，但有时仍需要纵隔入路。近年来，已采用侵入性较小的方法替代正中胸骨切开术。在本研究中，我们调查了因胸骨后甲状腺肿（RG）和纵隔甲状旁腺病变在我院接受胸骨劈开术患者的切口充分性和发病率。
回顾性分析2010年1月至2021年1月期间，因胸骨后甲状腺病变或纵隔异位甲状旁腺腺瘤，除颈部切口外还接受胸骨劈开术，或从胸骨切迹至第三肋间间隙行单独垂直切口的胸骨劈开术患者的病历。调查手术成功率、胸骨劈开术提供的暴露情况和并发症发生率。
12例行胸骨劈开术的患者纳入研究。患者的平均年龄为57.25±12.62（44 - 83）岁。8例（66.7%）患者为女性，4例（33.3%）患者为男性。手术指征为3例（25%）患者为多结节性甲状腺肿（MNG），3例（25%）患者为复发性MNG，3例（25%）患者为甲状旁腺功能亢进，3例（25%）患者为甲状腺癌。术后6例（50%）患者出现短暂性低钙血症，1例（8.3%）患者出现单侧声带麻痹，所有并发症平均在3周内自发缓解。所有患者均无需行正中胸骨切开术。
胸骨劈开术是一种对于无法通过颈部入路切除的RG和纵隔甲状旁腺病变手术成功的充分且适用的方法。
