胸内甲状腺肿的外科治疗

目的 探讨胸内甲状腺肿的诊断和治疗。方法 回顾性总结分析上海市胸科医院在1985～2001年手术治疗的57例胸内甲状腺肿病例资料，并复习相关文缺。结果 36例低位颈横切口，6例颈横切口 正中切口，7例正中切口，8例胸部后外、前外切口，无手术死亡，良性病变47例，10例恶性，术后气管切开4例，声嘶7例，甲状腺功能减退2例。结论 胸内甲状腺肿的诊断主要根据症状、体征、胸片、CT、一旦诊断本症，即应手术治疗，避免严重压迫症状发生，大多经颈横切口可切除，少数需其他切口。     

胸内甲状腺肿32例的外科治疗

目的 探讨胸内甲状腺肿的最佳治疗方法。方法 分析1984－2000年手术治疗胸内甲状腺肿32例的临床资料。结果 根据病人的临床症状，X线、同位素扫描，CT，MRI等检查确立诊断。手术入路一般分3种：（1）颈部低位领式切口；坠入胸腔内的甲状腺多可经此切口完成手术（本组25例）。此切口便于处理甲状腺上、下血管及中静脉，减少喉返神经损伤的机会。（2）低位领形切口加纵劈胸骨：适用于较大的甲状腺不能自胸廓入口取出、疑有恶性变、粘连严重或低位领形切口操作困难者（本组3例）。（3）开胸手术；适用于迷走性甲状腺肿或坠入深度在12cm以上或从颈部取出困难及术前诊断不明（本组4例）。术后并发症9例，占28．1％，比同期颈部甲状腺肿手术的并发症高。结论 手术切除是胸内甲状腺肿的最佳治疗方法。根据坠入胸内甲状腺的不同情况，采用不同的手术径路，以获损伤最小、疗效最佳的结果。本组手术径路以低位领式口为主，只有在颈部入路操作困难时再加胸骨纵劈及开胸术。     

伴合并症的胸内甲状腺肿的围手术期处理

胸内甲状腺肿是指肿大的甲状腺部分或全部位于胸廓入口以下及肿大的甲状腺原发于纵膈内[1-2],由于其位置与颈部甲状腺疾病不同,故临床表现、诊断和手术都有其特殊性[3].1991年4月至2009年10月,四川省肿瘤医院胸外、头颈外科诊治胸内甲状腺肿合并吞咽梗阻、呼吸困难、上腔静脉综合征19例,现将其围手术期的处理报告如下.     

胸内甲状腺肿的外科治疗（附20例报告）

报告１９７０年到１９９４年间通过手术切除并经病理证实为胸内甲状腺肿２０例。胸内甲状腺肿是指肿大的甲状腺部分或全部位于胸廓入口以下。绝大多数胸内甲状腺肿是由颈部甲状腺肿大延伸而来，真正起源于胸腔的迷走性甲状腺肿极少。本病多发生在４０岁以上的病人，以女性居多。主要症状是气管受压引起的呼吸困难、喘鸣等。Ｘ线胸片、ＣＴ、同位素扫描是常用的诊断手段。手术切除为首选治疗方法，三种主要手术入路为颈部领式切口、纵劈胸骨法和开胸法。     

31例胸内错构瘤的诊断与外科治疗

目的：研究胸内错构瘤的特点，以确定诊断和治疗方案。方法：对我科1981年4月至1998年4月的胸内错构瘤病例进行回顾性分析。结果：31例，肺内型29例，肺外型2例，术前确诊率16．1％。2例有潜在生长趋势，1例与锁骨下动静脉联系紧密。结论：肺错构瘤临床误诊率高，且有恶变趋势，应以手术治疗为主。     

胸骨后甲状腺肿的诊断与治疗

胸骨后甲状腺肿多由结节性甲状腺肿、甲状腺腺瘤引起，少数也可由甲状腺功能亢进、甲状腺癌引起。甲状腺肿可使颈部大血管、气管受压移位及变窄，故手术操作难度较大、风险较高和并发症较多。本文着重从术前诊断、麻醉的选择、手术方式及术后并发症的防治方面进行阐述。     

胸内脊膜膨出症的诊断与治疗

目的 胸内脊膜膨出症极易误诊为纵隔囊肿，故探讨其病因、诊断和治疗方法。方法 统计1979～2002年武汉大学人民医院及北非Medea省医院、Mascara省医院收治的860例纵隔肿瘤和纵隔包囊虫病例，其中有4例为胸内脊膜膨出症。2例为常规体检时发现，l例术前诊断为肺包囊虫病，l例术前5年曾行胸脊膜膨出缝扎术。结果 3例术前未确诊，而是手术中校正诊断，经手术治愈；l例未治疗。3例术后随访5～l0年，病变未复发。结论 胸内脊膜膨出症是一种罕见的先天性畸形，术中囊内穿刺抽出液为无色清亮液，化验为脑脊液即可确诊。根据病变部位、椎间孔大小及有否神经纤维或脊髓疝出决定手术切除组织范围，或囊颈口缝合、修补；或加自体心包片、带蒂肌瓣、阔筋膜，涤纶片加固。术中禁忌钝性分离、大块钳夹。     

巨大甲状腺肿172例手术治疗分析

目的提高巨大甲状腺肿手术治疗水平。方法对172例巨大甲状腺肿行双侧甲状腺大部分切除或甲状腺全切除术。结果所有病例术后病理诊断均为结节性甲状腺肿(100%),合并癌变7例(4%),继发性甲亢9例(5.2%),无死亡病例。结论合适的麻醉方法,充分的术野显露,准确识别病理状态下的甲状腺血管和毗邻神经的走行变异,有效地控制和预防出血等均是影响巨大甲状腺肿手术切除疗效的重要因素。     

胸骨后甲状腺肿的诊断与外科治疗

胸骨后甲状腺肿多由结节性甲状腺肿、甲状腺腺瘤引起,少数也可由甲状腺功能亢进、甲状腺癌引起.甲状腺肿可使颈部大血管、气管受压移位及变窄,故手术操作难度较大、风险较高和并发症较多.本文着重从术前诊断、麻醉的选择、手术方式及术后并发症的防治方面进行阐述.     

胸骨后甲状腺肿的诊断与治疗

胸骨后甲状腺肿因其部位特殊,在诊断与治疗中除与颈部甲状腺肿有相似之处外,还有其自身特点,自1988年4月至2008年10月我们共手术治疗胸内甲状腺肿39例。现对其分类、临床诊断及治疗方法报告如下。     

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目的 探讨胸内甲状腺肿的诊断方法及手术方式。方法 收集1958－2000年间经病理证实为胸内甲状腺肿65例。结果 主要依靠临床症状、X线、同位素扫描、CT检查诊断。肿物下极在主动脉弓上缘水平以上者41例（63．1％），在此水平以下者24例（36．9％）。均行手术治疗，手术径路分为颈部领式切口41例（63．1％），低位领式切口加胸骨正中切开11例（17．0％），开胸18例（12．3％），颈胸联合切口3例（4．6％），胸骨正中切开2例（3．0％）。术后并发症发生率15．4％，其中喉返神经损伤发生率7．7％；死亡率为1．5％。结论 手术切除是胸内甲状腺肿的首选治疗方法，喉返神经务是术后主要并发症，应注意预防其发生。并依据肿物不同情况采取不同的手术径路，宜先行衣领式切口，估计操作困难，病变达主动脉弓下者，应行胸骨切开或开胸处理。     

结节性甲状腺肿合并甲状腺癌38例诊治分析

目的 探讨结节性甲状腺肿合并甲状腺癌的诊治方法.方法 回顾性分析我院2000年1月至2006年12月手术治疗的635例结节性甲状腺肿病例中38例并存甲状腺癌患者的临床资料.结果 同期手术治疗结节性甲状腺肿患者635例,合并甲状腺癌38例(5.98%),病理检查结果:微小癌变17例,双叶癌7例,乳头状癌23例,滤泡状癌7例,髓样癌4例,未分化癌3例,甲状腺肉瘤样伴鳞癌分化1例,所有患者均行术中快速冷冻病理检查,并根据病理检查结果采取不同的手术方式.结论 结节性甲状腺肿术前检查怀疑甲状腺癌者应行细针穿刺及术中快速冰冻切片病理检查有利于确诊,可有效避免再次手术;甲状腺全切 131I放射治疗残余灶和/或转移灶 足量L-型甲状腺素钠抑制治疗有利于降低复发和死亡.     

Powered instrumentation for transcervical removal of gigantic intrathoracic thyroid

BACKGROUND: It is widely accepted that almost all intrathoracic goiters can be removed through the neck. For those rare gigantic goiters that cannot be removed transcervically, median sternotomy is usually recommended. During the last 11 years we used intracapsular volume reduction techniques to facilitate transcervical removal of extremely large intrathoracic goiters. Materials and Methods Of 149 patients with intrathoracic goiters, 11 patients had gigantic lesions that could not be removed transcervically. Instead of sternotomy, we used the arthroscopic or sinus microdebrider or a large-bore suction device for controlled intracapsular volume reduction. This was followed by complete removal of the gland through the neck. RESULTS: The thyroid gland was removed completely in all 11 patients. None of the patients had any evidence of intraoperative spillage of thyroid tissue. No major complications were noted. CONCLUSIONS: We have found the use of the microdebrider and/or suction device for intracapsular volume reduction to be extremely helpful for transcervical removal of gigantic intrathoracic goiters.     

Thyroid carcinoma in intrathoracic goiter

Introduction: Most cases of intrathoracic goiter can be managed by cervical incision alone. A thoracic approach may be needed when adhesions or an anomalous blood supply are present or carcinoma is suspected. Patients and methods: Only 44 patients out of 5263 operated on for goiter needed a thoracic incision. A sternotomy was performed in 29 cases and a thoracotomy in 15; a malignancy was present in 9 cases. Symptoms, surgical approach, histology, survival and pTN staging of these 9 patients were reviewed and discussed; no perioperative mortality was observed. Discussion: A thoracic approach is more frequently needed for treatment of intrathoracic thyroid carcinoma as it offers a greater chance of radical excision and better control of intraoperative bleeding. Histologically, thyroid carcinoma in intrathoracic goiter is often anaplastic or rare and has a poor long-term survival rate when compared to cervical forms. Received: 2 February 1998 / Accepted: 23 June 1998     

Results of surgical treatment in multinodular goiter with an intrathoracic component

PURPOSE: (1) To determine the clinical profile of intrathoracic multinodular goiter (IMG); (2) to evaluate the results of surgery, and (3) to analyze the incidence of malignancy and its evolution. METHODS: Two hundred and forty-seven operated cases of IMG were reviewed. These cases of IMG had all been diagnosed according to Eschapse's definition (>3cm below the sternal manubrium). The morbidity and postoperative evolution were analyzed. A comparative study was carried out on a group of 425 cases of nonintrathoracic goiter. We applied the chi(2) test, Student's t-test, and a logistical regression analysis. RESULTS: Intrathoracic MG occurs in patients over 60 years of age, with goiter which has a long evolution time (>12 years), and more than 60% are symptomatic. Oral tracheal intubation was difficult in 10% (n = 24) of the cases, and 7 required the use of a fibrobronchoscope. In 8 cases (3%) a thoracic approach was necessary. Morbidity occurred in 24% (n = 59), most notably 29 recurring lesions (12%), of which 2 were definitive (0.8%), and 31 hypoparathyroidisms (13%), of which 1 was definitive (0.4%). No significant difference was found in the postsurgical morbidity between the intrathoracic MG and the nonintrathoracic cases. Regarding the remission of the symptoms, the results were excellent. In 14 cases (5.7%) thyroid carcinoma was related with, most of these being papillary microcarcinoma. In 10 of the 49 cases of partial surgery (20%) a relapse of the goiter was observed. CONCLUSIONS: Intrathoracic MG is usually asymptomatic and it occurs in goiter with a long time of evolution. Surgery is a good therapeutic option given that the goiter can be removed via the neck, with low morbidity, a remission of the symptoms, malignancy is ruled out, and recurrence can be avoided if a total thyroidectomy is performed.     

结节性甲状腺肿合并甲状腺癌的诊治分析

目的提高结节性甲状腺肿合并甲状腺癌的诊断和治疗水平。方法回顾性分析我院近年收治的158例结节性甲状腺肿患者的临床资料,所有患者均首先采用单侧或双侧甲状腺次全切除术,术中送冰冻病理检查,根据冰冻病理结果或石蜡切片病理结果补充行患侧甲状腺叶全切＋峡部＋对侧甲状腺叶次全切除术。结果158例结节性甲状腺肿患者中,合并甲状腺癌23例,其中乳头状腺癌22例,滤泡状腺癌1例。术后随访5-12个月,1例患者出现颈部淋巴结肿大,再次行功能性颈部淋巴结清扫术。Logistic回归分析显示,判断结节性甲状腺肿合并甲状腺癌的因素中,结节个数较少与结节直径较小是结节性甲状腺肿合并甲状腺癌的危险因素。结论对某些虽然无明确症状,但发现甲状腺有较小的实性结节的结节性甲状腺肿患者应持更积极的治疗态度。     

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。