Shaha A, Alfonso A, Jaffe B M
Department of Surgery, State University of New York Health Science Center, Brooklyn 11203.
Surgery. 1987 Dec;102(6):1068-74.
Patients with multinodular goiter or related thyroid disorders rarely have acute airway distress due to tracheal deviation or compression. However, our institution cares for a large number of patients with untreated multinodular goiters, and in the progression of this disorder, tracheal deviation and airway problems are relatively common. During the past 4 years, we have cared for 24 patients who were admitted with acute, life-threatening airway distress that required emergency intervention. Nine patients had emergency intubation, the remaining 15 had stridor on admission and underwent emergency operations. The series consists of 19 females and five males whose ages ranged from 37 to 89 years. Only four patients had malignant thyroid lesions (two papillary-follicular, two anaplastic), and two of these had multiple pulmonary metastases. Fifteen of the patients with multinodular goiters had a mediastinal extension that led to marked tracheal deviation. Three patients had recurrent multinodular goiters decades after previous surgery. Twenty-one patients underwent surgery at our institution, and all did well. Only one patient required sternotomy for thyroidectomy. Two patients required tracheostomy procedures, one because of tracheomalacia and the other because of poor pulmonary reserve. Interestingly, two patients had acute symptoms when in their third trimester of pregnancy. We have routinely used the laryngoscope (fiberoptic rigid or flexible) for preoperative and postoperative evaluation of the vocal cords and for determination of the condition of the larynx. On the basis of our experience with acute airway distress, we strongly advocate elective surgery for patients with multinodular goiter at the first sign of tracheal compression, especially if they have mediastinal extension.
患有结节性甲状腺肿或相关甲状腺疾病的患者很少因气管移位或受压而出现急性气道窘迫。然而，我们机构诊治了大量未经治疗的结节性甲状腺肿患者，在这种疾病的进展过程中，气管移位和气道问题相对常见。在过去4年里，我们诊治了24例因急性、危及生命的气道窘迫入院且需要紧急干预的患者。9例患者进行了紧急插管，其余15例入院时出现喘鸣并接受了急诊手术。该系列包括19名女性和5名男性，年龄在37至89岁之间。只有4例患者有甲状腺恶性病变（2例乳头状滤泡性、2例未分化性），其中2例有多处肺转移。15例结节性甲状腺肿患者有纵隔延伸，导致明显的气管移位。3例患者在先前手术后数十年出现复发性结节性甲状腺肿。21例患者在我们机构接受了手术，术后情况均良好。只有1例患者因甲状腺切除需要进行胸骨切开术。2例患者需要气管切开术，1例是因为气管软化，另1例是因为肺储备功能差。有趣的是，2例患者在妊娠晚期出现急性症状。我们常规使用喉镜（纤维硬性或软性）对声带进行术前和术后评估以及确定喉部情况。基于我们对急性气道窘迫的经验，我们强烈主张对出现气管受压首个迹象的结节性甲状腺肿患者进行择期手术，尤其是那些有纵隔延伸的患者。
