甲状腺疾病所致气管狭窄的发生和处置

目的探讨甲状腺疾病所致气管狭窄发病的特殊性及其诊疗对策。方法回顾10例不同原因甲状腺疾病所致气管狭窄的误诊情况、诊断方法包括纤支镜检查和／或颈部CT检查，甲状腺扫描和病理检查；处理方法包括甲状腺切除手术和人工气道重建。结果10例甲状腺疾病所致气管狭窄患者中，误诊为“支气管哮喘”3例，误诊为急性左心衰2例：经纤支镜检查和／或颈部检查均可见气管外压性Ⅱ～Ⅲ度狭窄；甲状腺疾病经病理检查确认。人工气道重建后均可缓解气管狭窄，以气管内支架置入术效果最佳，气管切开套管置人次之。结论甲状腺疾病所致气管狭窄易于误诊，提高警惕性则诊断不难；甲状腺切除手术和人工气道重建可有效缓解气管狭窄，但预后取决于甲状腺疾病性质、狭窄程度和处理方法。

Management of thyroid disease-induced tracheostenosis

OBJECTIVE: To investigate the special clinical characteristics of thyroid disease-induced tracheostenosis and elaborate on its clinical management. METHODS: A retrospective analysis of 10 cases of thyroid disease-induced tracheostenosis was performed by reviewing the clinical record of their misdiagnoses and diagnostic approaches with fiberoptic bronchoscopy and/or cervical CT, thyroid scanning and pathological examination. The management included resection of the thyroid gland and airway reconstruction. RESULTS: Of the 10 patients, 3 were misdiagnosed to have bronchial asthma and 2 had a misdiagnosis of acute heart failure. Compression-induced tracheostenosis of grade II or III was identified by fiberoptic bronchoscopy or cervical CT, and the diagnosis of thyroid gland disease was established after pathological examination. Severe dyspnea was relieved in all patients after thyroid gland resection and airway reconstruction. Expandable metal stent placement was the most effective therapy for tracheostenosis induced by nodular goiter. Patients with tracheostomy cannula placement were at high risk of severe infection. CONCLUSIONS: Thyroid disease-induced tracheostenosis is likely to be misdiagnosed, which is not difficult to prevent with constant awareness of the possibility. Severe dyspnea in these patients can be relieved effectively after thyroid gland resection and airway reconstruction, and the prognosis depends on the type of the thyroid disease, degree of the tracheostenosis and management approaches.