Obadiel Yasser A, Al-Shehari Mohammed, Algmaly Yaseen, Al-Jammra Bilquis, Kahtan Iman, Tashan Nashwan, Ahmed Faisal
General Surgery, Al-Thawra Modern General Hospital, Sana'a, YEM.
General Surgery, Faculty of Medicine and Health, Sana'a University, Sana'a, YEM.
Cureus. 2024 Mar 20;16(3):e56573. doi: 10.7759/cureus.56573. eCollection 2024 Mar.
The preferred standard treatment for retrosternal goiter (RSG), a slow-growing, often benign tumor, remains thyroidectomy. An alternative strategy may be required when the goiter is intrathoracic. Data on the results of RSG procedures are rarely reported. Careful patient selection and assessment are critical to avoiding an unexpected sternotomy during surgery and postoperative complications. This study aims to examine the clinical findings and treatment outcomes of RSG and to identify the variables affecting postoperative complications in a resource-limited setting.
A retrospective study was conducted at Al-Thawra Modern General Hospital in Sana'a, Yemen, on 69 patients diagnosed with RSG and undergoing thyroidectomy between April 2019 and February 2023. Initial clinical characteristics, radiological and laboratory findings, treatment approach, and outcome were collected from the patient's medical profile and analyzed. To determine the variables influencing postoperative complications, a bivariate analysis was carried out.
The mean age was 51.0 ± 13.6 years, and 45 (65.2%) were female. The most commonly reported symptoms were palpable masses (66; 95.7%), difficulty breathing (45; 65.2%), and neck discomfort (20; 29.0%), with 7 (10.1%) patients being asymptomatic. Previous thyroid surgery was reported in 10 (14.5%) cases. According to the grading classification, grade 1 was the most prevalent (42; 60.9%). Total thyroidectomy was the predominant surgical procedure in 59 (85.5%) cases. Using a cervical approach, all patients underwent thyroidectomy, and a sternotomy was required in one case. Histopathological analysis revealed benign multinodular goiter in 79.7%, followed by papillary thyroid cancer in 10.1% and thyroiditis in 6.7%. The postoperative complication occurred in 22 (31.9%), and the most common complication was transient hypocalcemia (11, 15.9%). There was no mortality during or after the surgery. In bivariate analysis, advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology were associated with postoperative complications and were statistically significant (all p<0.05).
RSG is a rare disease that may require challenging surgical intervention. In this study, the cervical approach was the most practical and least intrusive surgical method. In addition, postoperative complications were associated with advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology. Low postoperative complication rates can be achieved by understanding the surgical architecture of the neck, essential clinical RSG presentation, thyroid pathology, and necessary surgical treatment.
胸骨后甲状腺肿（RSG）是一种生长缓慢、通常为良性的肿瘤，其首选的标准治疗方法仍然是甲状腺切除术。当甲状腺肿位于胸腔内时，可能需要采用替代策略。关于RSG手术结果的数据很少被报道。仔细的患者选择和评估对于避免手术中意外的胸骨切开术和术后并发症至关重要。本研究旨在检查RSG的临床发现和治疗结果，并确定在资源有限的环境中影响术后并发症的变量。
在也门萨那的Al-Thawra现代综合医院进行了一项回顾性研究，对2019年4月至2023年2月期间诊断为RSG并接受甲状腺切除术的69例患者进行研究。从患者的病历中收集初始临床特征、放射学和实验室检查结果、治疗方法及结果，并进行分析。为确定影响术后并发症的变量，进行了双变量分析。
平均年龄为51.0±13.6岁，45例（65.2%）为女性。最常报告的症状是可触及肿块（66例，95.7%）、呼吸困难（45例，65.2%）和颈部不适（20例，29.0%），7例（10.1%）患者无症状。10例（14.5%）患者曾有甲状腺手术史。根据分级分类，1级最为常见（42例，60.9%）。59例（85.5%）患者的主要手术方式为全甲状腺切除术。采用颈部入路，所有患者均接受了甲状腺切除术，1例需要进行胸骨切开术。组织病理学分析显示，79.7%为良性多结节性甲状腺肿，其次为乳头状甲状腺癌10.1%，甲状腺炎6.7%。22例（31.9%）发生术后并发症，最常见的并发症是短暂性低钙血症（11例，15.9%）。手术期间及术后均无死亡病例。在双变量分析中，高龄、吞咽困难、气管偏移、RSG肿块较大、RSG分级较高、既往手术史和恶性组织病理学与术后并发症相关，且具有统计学意义（均p<0.05）。
RSG是一种罕见疾病，可能需要具有挑战性的手术干预。在本研究中，颈部入路是最实用且侵入性最小的手术方法。此外，术后并发症与高龄、吞咽困难、气管偏移、RSG肿块较大、RSG分级较高、既往手术史和恶性组织病理学有关。通过了解颈部手术结构、RSG的基本临床表现、甲状腺病理学及必要的手术治疗，可实现较低的术后并发症发生率。
