Katlic M R, Grillo H C, Wang C A
Am J Surg. 1985 Feb;149(2):283-7. doi: 10.1016/s0002-9610(85)80086-6.
Eighty patients at the Massachusetts General Hospital underwent resection of substernal goiter in the years 1976 to 1982. Mean age of the 50 women and 30 men was 56 years, and 10 (19 percent) had undergone prior thyroid surgery. The most common symptoms were cervical mass (69 percent), dysphagia (33 percent), and dyspnea (28 percent); 13 percent were asymptomatic. On examination, cervical mass was present in most (90 percent) but not all patients, 51 percent were obese, and more than one third had tracheal deviation. Fifty-one of 52 patients tested were euthyroid and one was mildly hypothyroid. Chest radiographs showed tracheal deviation in 79 percent and soft tissue mass in 56 percent. Seventy-eight patients underwent resection through a cervical collar incision only; one had cervical incision plus upper partial sternotomy; and one required cervical incision plus full median sternotomy. Pathologic examination revealed multinodular goiter in 41 (51 percent), follicular adenoma in 35 (44 percent), and Hashimoto's thyroiditis in 4 (5 percent). Mean goiter weight was 104 g, and the mean greatest dimension was 9 cm. Occult papillary carcinoma was found in two patients. There were no deaths or major complications. Analysis of our data indicate the following: (1) Substernal goiter may exist in the absence of symptoms or signs. (2) Extensive radiologic evaluation and thyroid function testing are rarely required. (3) With rare exceptions, substernal goiter represents an extension of a cervical growth through the thoracic inlet and can be approached through a cervical collar incision. (4) Histologically, these are multinodular goiters or follicular adenomas, although Hashimoto's thyroiditis may occur. (5) Given the small but present risks of acute stridor or occult malignancy and the negligible surgical risk, operation should be recommended. (6) Patients should be followed since, with or without levothyroxine, goiters may recur.
1976年至1982年间，80例患者在马萨诸塞州总医院接受了胸骨后甲状腺肿切除术。其中50名女性和30名男性的平均年龄为56岁，10人（19%）曾接受过甲状腺手术。最常见的症状为颈部肿块（69%）、吞咽困难（33%）和呼吸困难（28%）；13%的患者无症状。检查发现，大多数（90%）但并非所有患者都有颈部肿块，51%的患者肥胖，超过三分之一的患者有气管偏移。52例接受检测的患者中，51例甲状腺功能正常，1例轻度甲状腺功能减退。胸部X线片显示，79%的患者有气管偏移，56%的患者有软组织肿块。78例患者仅通过颈部衣领状切口进行了切除；1例患者进行了颈部切口加部分上胸骨切开术；1例患者需要颈部切口加全胸骨正中切开术。病理检查显示，41例（51%）为结节性甲状腺肿，35例（44%）为滤泡性腺瘤，4例（5%）为桥本甲状腺炎。甲状腺肿平均重量为104克，最大平均直径为9厘米。两名患者发现了隐匿性乳头状癌。无死亡病例或严重并发症。对我们数据的分析表明：（1）胸骨后甲状腺肿可能在没有症状或体征的情况下存在。（2）很少需要进行广泛的放射学评估和甲状腺功能检测。（3）除极少数情况外，胸骨后甲状腺肿是颈部肿物经胸廓入口的延伸，可通过颈部衣领状切口进行处理。（4）从组织学上看，这些是结节性甲状腺肿或滤泡性腺瘤，尽管可能发生桥本甲状腺炎。（5）鉴于急性喘鸣或隐匿性恶性肿瘤的风险虽小但存在，而手术风险可忽略不计，应建议手术治疗。（6）患者应接受随访，因为无论是否使用左甲状腺素，甲状腺肿都可能复发。
