Linhares Samantha M, Scola William H, Remer Lindsay F, Khan Zahra F, Nguyen Dao M, Lew John I
Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL.
Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL.
Surgery. 2022 Nov;172(5):1373-1378. doi: 10.1016/j.surg.2022.06.026. Epub 2022 Aug 26.
Surgical excision of substernal thyroid goiters is usually achieved through a conventional transcervical approach, and transthoracic excision is rarely necessary. Currently, there are no clear guidelines for substernal thyroid goiters that may require a transthoracic approach. This study examined what preoperative factors were significantly associated with transthoracic surgical excision for substernal thyroid goiters.
A retrospective review of prospectively collected data of 109 patients with substernal thyroid goiters from a single institution was performed. The patients were stratified by transcervical and transthoracic approaches for substernal thyroid goiters. The factors possibly predictive of a transthoracic approach, including substernal extension beyond the thoracic inlet, patient-reported symptoms, tracheal deviation, and malignancy, were analyzed. Demographics including age, sex, and race, among others, were also studied.
Of 1,080 patients who underwent surgical resection for multinodular goiter, there were 109 (10%) patients with substernal thyroid goiters. Of the substernal thyroid goiter group, 11 (10%) patients underwent partial sternotomy, whereas 6 (5.5%) underwent total sternotomy. On logistic regression, only substernal component of the thyroid goiter extending beyond the sternal notch into the mediastinum was statistically significant in predicting sternotomy (odds ratio 3.43, confidence interval 1.65-6.41, P < .001). Substernal thyroid goiters with mediastinal extension of ≥5 cm beyond the sternal notch showed a sensitivity of 94% and specificity of 86.5% to predict need of sternotomy.
Patients with substernal thyroid goiters who exhibit progressive enlargement and/or compressive symptoms should undergo surgical excision. Although most are removed through the conventional transcervical approach, substernal thyroid goiters with a depth of mediastinal extension ≥5 cm have a high likelihood of requiring sternotomy.
胸骨后甲状腺肿的手术切除通常通过传统的经颈入路完成，很少需要经胸切除。目前，对于可能需要经胸入路的胸骨后甲状腺肿尚无明确的指南。本研究探讨了哪些术前因素与胸骨后甲状腺肿的经胸手术切除显著相关。
对来自单一机构的109例胸骨后甲状腺肿患者的前瞻性收集数据进行回顾性分析。患者按胸骨后甲状腺肿的经颈和经胸入路进行分层。分析了可能预测经胸入路的因素，包括胸骨后延伸超过胸廓入口、患者报告的症状、气管偏移和恶性肿瘤。还研究了包括年龄、性别和种族等人口统计学特征。
在1080例行多结节性甲状腺肿手术切除的患者中，有109例（10%）患有胸骨后甲状腺肿。在胸骨后甲状腺肿组中，11例（10%）患者接受了部分胸骨切开术，而6例（5.5%）接受了全胸骨切开术。在逻辑回归分析中，只有甲状腺肿的胸骨后部分延伸超过胸骨切迹进入纵隔在预测胸骨切开术方面具有统计学意义（优势比3.43，置信区间1.65 - 6.41，P <.001）。胸骨后甲状腺肿纵隔延伸超过胸骨切迹≥5 cm对预测胸骨切开术的敏感性为94%，特异性为86.5%。
出现进行性增大和/或压迫症状的胸骨后甲状腺肿患者应接受手术切除。虽然大多数通过传统的经颈入路切除，但纵隔延伸深度≥5 cm的胸骨后甲状腺肿很可能需要胸骨切开术。
