Wang L S, Shai S E, Fahn H J, Chan K H, Chen M S, Huang M S
Department of Surgery, Veterans General Hospital-Taipei, National Yang-Ming Medical College, Taiwan, Republic of China.
Scand J Thorac Cardiovasc Surg. 1994;28(2):79-83. doi: 10.3109/14017439409100167.
Seventeen cases of large substernal goiter are reviewed. The commonest clinical features were frequent upper respiratory tract infections, dyspnea and a cervical mass. Five of the patients had previous thyroidectomy. The substernal goiter was located in the right chest in 11 cases, the left chest in five and bilaterally in one case. On computed tomograms it was pretracheal or prevascular in ten cases and retrovascular in seven. Tracheal deviation was present in 15 cases, causing tracheal compression or stenosis in 14. Thyroidectomy was performed on all 17 patients (8 subtotal, 9 total) through a low transverse collar incision. The recommended technique for substernal goiter extending from the neck to a level below the subcarinal region includes concomitant finger dissection and upward traction of the cervical thyroid through the subcapsular plane, with obliteration of the postresection substernal dead space by sutures. Follow-up radiography showed that all the deviated tracheas had resumed near normal position 2-3 months postoperatively and the average diameter of the compressed tracheas had increased significantly.
回顾了17例胸骨后巨大甲状腺肿病例。最常见的临床特征是频繁的上呼吸道感染、呼吸困难和颈部肿块。其中5例患者曾接受过甲状腺切除术。胸骨后甲状腺肿位于右胸11例，左胸5例，双侧1例。计算机断层扫描显示，10例位于气管前或血管前，7例位于血管后。15例出现气管移位，14例导致气管受压或狭窄。所有17例患者均通过低位横向领口切口进行了甲状腺切除术（8例次全切除，9例全切除）。对于从颈部延伸至隆突下区域以下水平的胸骨后甲状腺肿，推荐的技术包括通过囊下平面进行手指分离并向上牵引颈部甲状腺，并用缝线封闭切除术后胸骨后的死腔。随访影像学检查显示，所有移位的气管在术后2 - 3个月恢复到接近正常位置，受压气管的平均直径显著增加。
