Fadel E, Chapelier A, Lancelin C, Macchiarini P, Dartevelle P
Départment de Chirurgie thoracique, vasculaire et de Transplantation cardiopulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson.
Presse Med. 1996 May 18;25(17):787-92.
Intrathoracic goitres present as tumors of the upper mediastinum. Malignancy is uncommon, but sudden or progressive development often leads to compression of the trachea. We report here our experience with surgical exeresis.
From 1980 to 1995, we operated 62 patients with intrathoracic goitre. There were 23 men and 39 women (mean age 63 years). The main manifestations leading to diagnosis were dyspnea (n = 20; 32%) and identification of a mediastinal formation on routine chest x-rays (n = 19; 30%).
Antevascular goitre was seen in 24 patients (39%) and retrovascular goitre in 38 (61%). The retrovascular goitres were located anteriorly and laterally to the trachea in 21 patients (34%) and posteriorly in 17 (27%). Simple cervicotomy was used in 57 patients (92%). Manubriotomy (n = 1) and total sternotomy (n = 4) were also required. All intrathoracic goitres removed were benign. Post-operative mortality was nul and morbidity was 11%: 2 cases of hypocalcemia and 2 tracheomalacias including 1 with recurrent nerve palsy and one with hematoma and pulmonary infection.
Surgical exeresis of intrathoracic goitre is essentially required in case of respiratory distress due to compression of the trachea. Morbidity is low with simple cervicotomy.
胸内甲状腺肿表现为上纵隔肿瘤。恶性情况并不常见，但突然或进行性发展常导致气管受压。我们在此报告手术切除的经验。
1980年至1995年，我们对62例胸内甲状腺肿患者进行了手术。其中男性23例，女性39例（平均年龄63岁）。导致诊断的主要表现为呼吸困难（20例；32%）和常规胸部X线检查发现纵隔肿物（19例；30%）。
24例患者（39%）为血管前甲状腺肿，38例（61%）为血管后甲状腺肿。21例（34%）血管后甲状腺肿位于气管前方和外侧，17例（27%）位于气管后方。57例患者（92%）采用单纯颈部切口。还需要1例胸骨柄切开术和4例全胸骨切开术。所有切除的胸内甲状腺肿均为良性。术后死亡率为零，发病率为11%：2例低钙血症和2例气管软化，其中1例伴有喉返神经麻痹，1例伴有血肿和肺部感染。
因气管受压导致呼吸窘迫时，胸内甲状腺肿基本上需要手术切除。单纯颈部切口发病率低。
