Sarin Vanita, Singh Divya, Rana Uday, Chopra Ishita
Department of Otorhinolaryngology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India.
Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India.
Indian J Otolaryngol Head Neck Surg. 2023 Dec;75(4):3014-3020. doi: 10.1007/s12070-023-03891-2. Epub 2023 Jun 3.
Retrosternal goitre (RSG) is a thyroid gland with more than 50% of its mass located below the thoracic inlet. Pre-operative Computed Tomography can visualise the anatomical relations between the RSG and each mediastinal component, and the level of extension. Most cases of RSG can be resected via the cervical approach, as the thoracic approach carries a greater risk of complications. We describe a four finger technique for total thyroidectomy in five cases of RSG through a neck incision, without the need for a sternotomy. The recurrent laryngeal nerve (RLN) was identified early in the Baehr's triangle. The thyroid was mobilised in the neck by ligation of the feeding vessels and separated from the tracheal attachments. The retrosternal portion was then delivered into the neck by blunt dissection, keeping two fingers of each hand close to the thyroid gland. The RLN and parathyroids were identified early in the surgery to avoid the complications of hoarseness and hypoalcemia, respectively.
胸骨后甲状腺肿（RSG）是指超过50%的甲状腺组织位于胸廓入口以下的甲状腺。术前计算机断层扫描可以显示RSG与每个纵隔结构之间的解剖关系以及延伸范围。大多数RSG病例可通过颈部入路切除，因为胸部入路并发症风险更高。我们描述了一种用于5例RSG患者经颈部切口行全甲状腺切除术的四指技术，无需胸骨切开术。在贝尔三角早期识别喉返神经（RLN）。通过结扎供血血管在颈部游离甲状腺，并使其与气管附着物分离。然后通过钝性分离将胸骨后部分送入颈部，双手各留两指靠近甲状腺。在手术早期识别RLN和甲状旁腺，分别避免声音嘶哑和低钙血症并发症。
