胸骨后甲状腺疾病的诊断和外科治疗

目的探讨胸骨后甲状腺病变的临床表现、诊断方法和手术治疗。方法回顾性分析我院1999年1月至2005年6月收治的47例胸骨后甲状腺肿的临床资料。结果46例为Ⅰ°坠人性胸骨后甲状腺肿,均为部分型,1例为Ⅱ°异位胸内甲状腺肿。良性病变45例,恶性病变2例。均行手术治疗,43例采用颈部低领式切口,3例采用颈部低领式切口+部分胸骨劈开,1例行胸骨劈开。行甲状腺大部切除术31例,双侧甲状腺次全切除术14例,甲状腺癌根治术1例,甲状腺癌姑息切除术1例。全组无手术及住院死亡,声嘶恢复正常5例,声嘶无改善2例,一过性手足抽搐4例,1例甲状腺鳞状细胞癌术后一月因肿瘤局部复发堵塞气管窒息死亡。结论绝大多数胸骨后甲状腺病变是颈部病变向下延续所致。CT扫描是最佳的术前检查手段。绝大多数患者的手术可经颈部低领式切口完成,必要时附加胸骨部分劈开。     

胸骨后甲状腺病变的诊断与外科治疗

目的探讨胸骨后甲状腺病变的临床表现、诊断、手术治疗和预后.方法对48例胸骨后甲状腺病变患者,均行手术治疗,38例采用颈部低领式切口,8例采用颈部切口附加胸骨纵行劈开径路,2例采用开胸切口.行甲状腺病变切除术38例,双侧甲状腺次全切除术6例,甲状腺癌根治性切除术4例.结果全组无手术死亡和住院死亡.随访39例,随访时间2～7年,1例甲状腺未分化癌患者术后生存13个月,3例甲状腺乳头状腺癌存活至今,分别存活2年、4年和7年,其余35例患者均健在,病变无复发.结论绝大多数胸骨后甲状腺病变与颈部甲状腺病变有关,胸内迷走甲状腺少见.其主要表现为气管受压.胸部X线片和CT等检查可确诊.多数患者手术可经颈部低领式切口完成,必要时附加胸骨部分劈开.无恶变患者,预后良好.     

胸骨后甲状腺肿的诊断与手术治疗

目的 分析胸骨后甲状腺肿的临床表现,比较各种诊断方法的敏感性、特异性,总结手术治疗要点和病理类型.方法 回顾性分析2001年-2005年间59例经手术治疗的胸骨后甲状腺肿患者的临床资料.结果 本组中胸骨后甲状腺肿主要表现为无症状颈部肿物(39例),其他表现包括憋气13例、甲亢症状4例、声音嘶哑3例、哽咽感3例、饮水呛咳1例等.胸片、B超、CT及核素显像对胸骨后甲状腺肿诊断的敏感性分别为:62.8%,15.8%,85.7%和50.0%;特异性分别为99.4%,99.8%,99.5%和99.0%.57例胸骨后甲状腺肿经颈切除,1例颈胸联合切除,1例开胸切除.术后病理:结节性甲状腺肿48例,Grave's病1例,腺瘤2例,甲状腺癌8例.结论 CT、胸片是胸骨后甲状腺肿诊断敏感性较高的检查方法,绝大多数胸骨后甲状腺肿可经颈部完成切除.     

胸骨后甲状腺肿的诊断和外科治疗

目的总结胸骨后甲状腺肿物的诊断及外科治疗。方法回顾性分析1996年3月~2006年3月16例胸骨后甲状腺肿物患者的临床资料。全组患者均接受手术治疗。结果无住院死亡和手术相关并发症发生,经病理证实结节性甲状腺肿10例,甲状腺滤泡型腺瘤3例,迷走甲状腺、迷走甲状旁腺伴囊性变及甲状腺乳头状癌各1例。结论根据肿物特点选择合理的手术入路是获得良好治疗效果的关键。     

胸骨后甲状腺肿18例手术治疗分析

目的探讨胸骨后甲状腺肿的外科手术治疗。方法回顾1995年1月至2006年12月期间手术治疗胸骨后甲状腺肿患者18例，其中16例行颈部低领式切口、2例行颈部低领式切口＋胸骨劈开入路切除胸骨后甲状腺肿。结果18例患者接受手术均获得成功，结节性甲状腺肿10例，甲状腺腺瘤5例，甲状腺炎3例，术后并发症发生率11．11％（2／18），无死亡。结论经颈部低领式切口切除胸骨后甲状腺肿是可行的，具有损伤小，操作简单，并发症少的优点。     

30例胸骨后甲状腺肿的外科治疗

目的 探讨胸骨后甲状腺肿的诊断、治疗和术后并发症.方法 回顾性分析我院1989年至2008年收治30例胸骨后甲状腺肿患者的诊断、治疗资料.结果 30例患者中,多结节性甲状腺肿24例,滤泡性甲状腺瘤2例,复发性甲状腺肿3例,亚急性甲状腺炎1例.28例手术可以通过颈部低位领形切口手术完成,2例需要劈开胸骨.主要的临床症状包括呼吸困难18例,吞咽困难5例,多汗症2例;术后并发症包括4例暂时的喉返神经损伤,血肿2例,短暂的低钙血症2例,2例声音嘶哑.结论 绝大多数胸骨后甲状腺肿患者完全可以选择用颈部低位领形切口手术,术中辨明并保护甲状旁腺和喉返神经对于减少术后并发症具有重要的意义.     

胸骨后甲状腺肿切除术的临床体会（附8例报告）

目的探讨胸骨后甲状腺肿的诊断和手术方式：方法收集1993-2004年间手术及病理证实为胸骨后甲状腺肿8例的临床资料。结果均以颈部低领状切口人路顺利完成手术，术后发生甲状腺危象2例，甲状腺功能减退1例，无喉返神经损伤及其他产重并发症，均临床治愈出院。结论(1)认识腺肿压迫气管引起气管痉挛等继发临床表现，并在围手术期加以控制，包括服碘、抗炎、解痉等药物治疗；(2)颈部低领状切口完全可满足本组胸骨后甲状腺肿切除术的需要。     

颈部入路治疗胸骨后良性甲状腺肿瘤的手术体会

目的：探讨胸骨后良性甲状腺肿瘤的临床诊断和治疗方法。方法：回顾分析我院1993年至2007年收治的24例胸骨后良性甲状腺肿瘤病人的临床资料。结果：所有病人均经颈部手术,无1例需劈开胸骨,无手术死亡病例,术后暂时性声音嘶哑2例,无其他严重并发症。结论：术前影像学检查有助于手术设计。进行经颈部低位领式切口切除对胸骨后甲状腺肿瘤安全可行,手术操作简单,损伤小,并发症少。     

26例舌异位甲状腺的临床诊断及治疗

目的提高临床对罕见的舌甲状腺的诊断和治疗水平。方法回顾性分析经外科手术病理证实的26例舌甲状腺患者的临床资料。结果全组无手术和住院死亡病例。术后2例并发甲状腺功能减退。并发症发生率为7.5%。结论绝大多数舌根部甲状腺伴有颈部甲状腺缺如。其多为异位的正常甲状腺腺体。同位素Ⅰ131扫描和超声可明确诊断。经口内进路法可完成绝大多数手术。手术切除的多少为愈合的关键问题。     

胸骨后甲状腺肿外科治疗20例

目的 探讨胸骨后甲状腺肿的外科治疗方法。方法 回顾性分析20例外科治疗胸骨后甲状腺肿的临床资料。结果 20例病人均采用颈部低位领状切口，汤匙方式切除甲状腺肿。结论 胸骨后肿大的甲状腺可压迫周围器官，并可恶变，诊断一但明确，宜早期手术。     

Retrosternal Goiter: The Need for Median Sternotomy

Introduction The aim of this study was to analyze the features of patients with goiter who underwent thyroidectomy via a cervical incision and a median sternotomy in Khartoum. Methods A total of 267 thyroidectomies were performed in Khartoum Teaching Hospital during the period from January 2002 to December 2003. There were 40 patients with evidence of retrosternal goiter (15%). Of those 40 patients, 13 had clinical and radiologic evidence of deep retrosternal extension of the goiter possibly necessitating sternotomy. Only 9 of the 13 patients actually required sternotomy, which accounted for 3.4% of all thyroidectomies performed (n = 267). The clinical, radiologic, and pathologic findings of those 9 sternotomy patients were analyzed and compared to those of the 258 patients who underwent cervical thyroidecomy. Results Total thyroidectomy was undertaken in all nine patients. Six of them had retrosternal extension on the right side of the mediastinum, and three had bilateral extension. Seven patients had symptoms of respiratory distress, and two were asymptomatic. The duration of the goiter ranged between 7 and 30 years. The chest radiograph and computed tomography scan revealed that the retrosternal part was below the level of the aortic knuckle at the tracheal bifurcation in all cases. The histopathology revealed a simple multinodular goiter in eight of the nine patients (89%) and in one patient with papillary carcinoma. Five of the nine patients underwent intraoperative prophylactic tracheostomy due to tracheomalacia. Conclusions A long-standing goiter with deep (below the aortic knuckle) mediastinal extension and tracheal space compromise can be postulated to increase the likelihood of sternotomy.     

Mediastinal goiter; report of a case

A 76-year-old female was admitted to our hospital because of an abnormal shadow on chest computed tomography (CT) which showed the tumor extending from left lower end of the thyroid to the aortic window along the left side of the trachea, indicating the retrosternal goiter. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were within normal ranges. The tumor was resected through cervical collar incision and median sternotomy. The pathological diagnosis was an adenomatous goiter. The patient was discharged without complications.     

Marzouk's procedure: a novel combined cervical and anterior mediastinotomy technique to avoid median sternotomy for difficult retrosternal thyroidectomy

Surgery for retrosternal goiter is uncommon. Most of the benign retrosternal goiters can be delivered and resected through a standard cervical incision. However, there are cases in which resection of the retrosternal goiter requires additional thoracic access to the standard transverse cervical incision in the form of partial or complete median sternotomy or even a thoracotomy. We propose and describe a novel technique of combining anterior mediastinotomy to the cervical incision as an adjunct to facilitate delivering the difficult retrosternal goiter by bi-manual manipulation. This technique avoids the trauma and postoperative morbidity of a median sternotomy or thoracotomy and proves effective in solving the technical, functional, financial, and aesthetic problems.     

The surgical approach to retrosternal goiters: The role of computerized tomography

OBJECTIVE: To assess preoperative CT scans of patients with a retrosternal goiter, with an objective of identifying features that are likely to predict the need for sternotomy at operation. STUDY DESIGN AND SETTING: A retrospective review of clinical notes and CT scans of patients who underwent thyroidectomy for retrosternal goiter at a large district general hospital in the United Kingdom between 1998 and 2002. RESULTS: Extension of the goiter to the level of the aortic arch, particularly when combined with tracheal involvement or major vessel displacement, increases the likelihood of requiring median sternotomy. CONCLUSIONS: Most retrosternal goiters can be approached through a cervical incision alone. However, extension of the goiter to the level of the aortic arch does appear to increase the likelihood of requiring sternotomy. SIGNIFICANCE: In such cases in which sternotomy is anticipated, the availability of cardiothoracic services would be helpful to avoid patient morbidity.     

Substernal goiter]

In a series of 363 patients operated for goiter, 60 were retrosternal (16.5%). The female incidence although less than in cervical goiters remains predominant (2.5:1). Most patients are in older age group, 68% being above 40 years. The majority of goiters are multinodular and of long duration. Bilateral (37%) and left sided location (43%) were common. The incidence of cancer was 7%, thyrotoxicosis was noted in 5 patients (8%). Most patients were symptomatic (97%). Diagnosis is easily done by physical examination, chest X-ray and thyroid scintigraphy. Computed tomography might be helpful. Retrosternal goiter is an indication to surgery except in high risk patients. The cervical approach has been used in 98% of cases. There were no post-operative death and no major complications (compressive hematoma, laryngeal nerve paralysis, hypocalcemia).     

双极电凝镊联合超声刀经颈部入路切除胸骨后甲状腺肿34例临床分析

目的探讨双极电凝镊联合超声刀经颈部入路切除胸骨后甲状腺肿治疗经验。 方法回顾性分析2013年7月至2020年12月收治的34例胸骨后甲状腺肿患者的病例资料。 结果根据术前分型，其中Ⅰ型9例，Ⅱ型17例，Ⅲ型8例。34例患者中，无明显临床症状者23例，表现为怕热多汗者1例，表现为吞咽困难、呼吸困难、声音嘶哑等压迫症状者10例。术后病理显示：良性31例，甲状腺乳头状癌1例，甲状腺滤泡性癌1例，甲状腺神经鞘瘤1例。患者均首选经颈部入路手术，其中有4例联合了胸骨劈开术。术后并发症发生率8.8%（3/34），均为术后暂时性四肢麻木，补钙治疗后症状消失，均顺利出院。 结论经过充分的术前评估和准备，双极电凝镊联合超声刀经颈部入路切除胸骨后甲状腺肿是安全有效的，能在手术过程中实施“精细化解剖”，最大限度地保护甲状旁腺、喉返神经等甲状腺周围组织器官。     

巨大甲状腺肿临床诊治体会

【摘要】〓目的〓总结巨大甲状腺肿围手术期处理的经验。方法〓回顾性分析总结我院甲状腺专业组2011年1月~2014年6月收治的67例巨大甲状腺肿患者的临床资料,所有患者均采用手术治疗,分析和总结临床疗效、手术治疗相关要素和手术要点。结果〓67例均顺利行手术治疗并康复出院,3例出现暂时性喉上神经麻痹,5例出现低钙血症,随访3个月均恢复正常。术后病理报告显示:34例为毒性弥漫性甲状腺肿,23例为结节性甲状腺伴纤维化、钙化,3例为毒性结节性甲状腺肿,3例为结节性甲状腺肿并慢性甲状腺炎,2例为甲状腺滤泡性腺癌,2例为甲状腺高功能腺瘤。结论〓个体化的术前准备、轻柔精细的解剖操作,是手术成功的重要因素。     

Management of retrosternal goiters: experience of a surgical unit

The aim of this study was to retrospectively analyze 5 years' experience of cervico-mediastinal goiters (CMG) management. Twenty-five patients with cervico-mediastinal goiters underwent surgery between January 1998 and December 2002. The group consisted of 16 females and 9 males (mean age, 48.2 years; range, 42-74 years). A total thyroidectomy under general anesthesia was always performed. A no. 7 Fogarty catheter with a 5-ml balloon was employed in the seven last cases to lift the retrosternal portion of the goiter into the neck. The mean postoperative stay was 3 days (range, 1-7 days), and the mean follow-up time was 29 months (range, 1-58 months). There were no postoperative deaths; overall morbidity rate was 28.0%. One patient with a severe life-threatening hematoma required surgical re-exploration. Surgery for CMGs shows a low morbidity rate; total thyroidectomy is the treatment of choice to prevent recurrences or re-surgery for malignancy.