Ghabisha Saif A, Ahmed Faisal, Al-Wageeh Saleh, Alyhari Qasem, Badheeb Mohamed A, Altam Abdulfattah, Alsharif Afaf
Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, YEM.
Department of Urology, Ibb University, Ibb, YEM.
Cureus. 2023 Jul 2;15(7):e41288. doi: 10.7759/cureus.41288. eCollection 2023 Jul.
Background Despite thyroidectomy being the preferred approach for retrosternal goiter (RSG), controversies surround its rationale in asymptomatic cases. This study aimed to investigate the treatment of RSG in resource-limited settings. Methods A retrospective study conducted between April 2010 and June 2022 included 28 RSG cases who underwent thyroidectomy using the cervical approach at Al-Nasar Hospital, Ibb, Yemen. A bivariate analysis was performed to investigate the risk factors for postoperative complications. Results The main age was 49.4±9.9 years, and most of them (60.7%) were females. The main symptoms were cervical mass appearance and breathing difficulty in 75 %, and 32.1%, respectively. Twenty-four (86%) cases were classified as Grade 1 (above aortic arch) and four (14%) cases were classified as Grade 2 (aortic arch to the pericardium). All patients underwent total thyroidectomy through the cervical approach without needing sternotomy. The mean operative time was 121.9±26.7min (99-200 min) and the mean intraoperative bleeding was 321.2±137.4 mL. Postoperatively, the malignant entity was histopathologically proven in seven patients (25%). The postoperative complications (14%) were transient hypocalcemia in two (7.1%) and hematoma in two (7.1%). Older age, bigger thyroid mass, extension below the aortic arch (Grade 2), longer operative time and bleeding, intensive care unit admission, and malignant features are associated with postoperative complications (all p < 0.05). Conclusion Cervical approach for patients with RSG in our experience is an optimum, feasible, and less invasive surgical approach, in a resource-limited setting. Older age, bigger thyroid, extension below the aortic arch, longer operative time and bleeding, intensive care unit admission, and malignant features are associated with postoperative complications.
尽管甲状腺切除术是胸骨后甲状腺肿（RSG）的首选治疗方法，但对于无症状病例的治疗依据仍存在争议。本研究旨在探讨资源有限地区RSG的治疗方法。方法：对2010年4月至2022年6月期间在也门伊卜省纳赛尔医院接受颈部入路甲状腺切除术的28例RSG患者进行回顾性研究。采用双变量分析探讨术后并发症的危险因素。结果：患者的平均年龄为49.4±9.9岁，其中大多数（60.7%）为女性。主要症状分别为颈部肿物出现和呼吸困难，发生率分别为75%和32.1%。24例（86%）病例被分类为1级（主动脉弓上方），4例（14%）病例被分类为2级（主动脉弓至心包）。所有患者均通过颈部入路行全甲状腺切除术，无需胸骨切开术。平均手术时间为121.9±26.7分钟（99 - 200分钟），平均术中出血量为321.2±137.4毫升。术后，7例患者（25%）经组织病理学证实为恶性病变。术后并发症发生率为14%，其中2例（7.1%）为短暂性低钙血症，2例（7.1%）为血肿。年龄较大、甲状腺肿物较大、延伸至主动脉弓下方（2级）、手术时间较长和出血较多、入住重症监护病房以及具有恶性特征与术后并发症相关（所有p < 0.05）。结论：根据我们的经验，对于资源有限地区的RSG患者，颈部入路是一种最佳、可行且侵入性较小的手术方法。年龄较大、甲状腺较大、延伸至主动脉弓下方、手术时间较长和出血较多、入住重症监护病房以及具有恶性特征与术后并发症相关。
