Sridar Krithiga, Mohiyuddin Sm Azeem, A Sagayaraj, Deo Ravindra, Mohammadi Kouser, Raju Kalyani, Munireddy Papireddy Sujatha
Otorhinolaryngology and Head and Neck Surgery, Sri Devaraj Urs Medical College, Kolar, IND.
Pathology, Sri Devaraj Urs Medical College, Kolar, IND.
Cureus. 2024 Nov 18;16(11):e73921. doi: 10.7759/cureus.73921. eCollection 2024 Nov.
Large retrosternal goiters often cause tracheal compression and deviation, leading to respiratory symptoms and complicating surgical treatment. Total thyroidectomy is the treatment of choice though it carries a risk of complications due to the altered anatomy and its proximity to vital structures. This study examines the outcomes of total thyroidectomy in patients with retrosternal goiters and assesses the impact of tracheal compression on clinical results.
This retrospective study included 32 patients treated with total thyroidectomy for retrosternal goiter between January 2018 and June 2024. Patient records were analyzed for clinical presentation, tracheal status, extent of retrosternal extension, intubation details, surgery performed, intraoperative findings, and postoperative complications. Tracheal compression and deviation were noted by preoperative imaging and flexible fiberoptic bronchoscopy. A correlation between difficult intubation and tracheal status was attempted. Complications such as hypocalcemia, recurrent laryngeal nerve palsy, and tracheomalacia were assessed alongside surgical variables.
Among the 32 patients, tracheal deviation was noted in 62.5% (n=20), and tracheal compression occurred in 43.8% (n=14). Complications included hypocalcemia in 43.8% (n=14) of cases, recurrent laryngeal nerve palsy in 6.25% (n=2), and tracheomalacia in 15.6% (n=5). Advanced airway management techniques such as flexible fiberoptic-assisted intubation were often required, particularly in cases with significant tracheal compression. Malignant goiters showed a higher incidence of tracheal deviation and postoperative complications but overall complication rates were comparable to benign cases.
Large retrosternal goiters carry the risk of airway compromise and surgical complications, particularly in the presence of tracheal compression. Hence, preoperative assessment of tracheal involvement and tailored surgical approaches are essential to manage airway complications and improve postoperative outcomes. A multidisciplinary approach is recommended for the management of these cases to enhance patient outcomes.
巨大胸骨后甲状腺肿常导致气管受压和移位，引发呼吸道症状并使手术治疗复杂化。全甲状腺切除术是首选治疗方法，尽管由于解剖结构改变及其与重要结构相邻，存在并发症风险。本研究探讨胸骨后甲状腺肿患者全甲状腺切除术的结果，并评估气管受压对临床结果的影响。
这项回顾性研究纳入了2018年1月至2024年6月期间接受全甲状腺切除术治疗胸骨后甲状腺肿的32例患者。分析患者记录，包括临床表现、气管状况、胸骨后延伸范围、插管细节、手术操作、术中发现及术后并发症。术前影像学检查和可弯曲纤维支气管镜检查记录气管受压和移位情况。尝试分析困难插管与气管状况之间的相关性。评估低钙血症、喉返神经麻痹和气管软化等并发症以及手术相关变量。
32例患者中，62.5%（n = 20）出现气管移位，43.8%（n = 14）发生气管受压。并发症包括43.8%（n = 14）的病例出现低钙血症，6.25%（n = 2）的病例出现喉返神经麻痹，15.6%（n = 5）的病例出现气管软化。通常需要采用高级气道管理技术，如可弯曲纤维支气管镜辅助插管，尤其是在气管严重受压的病例中。恶性甲状腺肿气管移位和术后并发症的发生率较高，但总体并发症发生率与良性病例相当。
巨大胸骨后甲状腺肿存在气道受损和手术并发症风险，尤其是在存在气管受压的情况下。因此，术前评估气管受累情况并采用针对性的手术方法对于处理气道并发症和改善术后结果至关重要。建议采用多学科方法管理这些病例以提高患者预后。
