Zohar Y
Dept. of Otolaryngology-Head and Neck Surgery, Hasharon Hospital, Golda Medical Center, Petah Tikva.
Harefuah. 1994 Aug;127(3-4):75-8.
Although goiter is not endemic in Israel, an iodine-rich country due to its bordering on the Mediterranean, we see many adults with massive goiters among immigrants from Afro-Asian and eastern European countries. 702 thyroidectomies were performed between January 1986 and March 1993 and 39 consecutive cases of goiter were studied. The patients ranged in age from 32-83 years (mean, 48); the female/male ratio was 36/3. There were 15 cases (13%) of thyroid carcinoma. In 1 case hyperthyroidism was diagnosed and treated preoperatively (3%) and in 2 others subclinical hypothyroidism was found (5%). The cervical approach was used, including cases with substernal extension. In only 1 was sternal splitting necessary. In our experience enlarged nodular goiter, with or without substernal extension, should be operated before symptoms of tracheal pressure develop and to avoid the risk of neglected malignancy hidden in an enlarged thyroid.
尽管由于以色列濒临地中海，是一个碘充足的国家，甲状腺肿并非地方病，但我们在来自亚非和东欧国家的移民中见到许多患有巨大甲状腺肿的成年人。1986年1月至1993年3月期间进行了702例甲状腺切除术，并对39例连续的甲状腺肿病例进行了研究。患者年龄在32至83岁之间（平均48岁）；男女比例为36比3。有15例（13%）甲状腺癌。1例术前诊断并治疗为甲状腺功能亢进（3%），另外2例发现亚临床甲状腺功能减退（5%）。采用颈部入路，包括有胸骨后延伸的病例。仅1例需要胸骨劈开。根据我们的经验，无论有无胸骨后延伸，肿大的结节性甲状腺肿都应在出现气管受压症状之前进行手术，以避免隐匿于肿大甲状腺内被忽视的恶性肿瘤风险。
