巨大甲状腺肿致气管软化的外科治疗

目的:探讨巨大甲状腺肿致气管软化的诊断及外科治疗方法。方法:12例巨大甲状腺肿致气管软化的患者均行X线气管摄片及颈部CT增强扫描检查,行双侧甲状腺次全切除和气管悬吊术11例,双侧甲状腺次全切除和气管切开术1例。结果:12例均获得临床治愈。未出现声嘶、呼吸困难等并发症。结论:巨大甲状腺肿致气管软化行甲状腺次全切除、气管悬吊术或气管切开术是积极有效的方法。     

巨大甲状腺肿合并气管软化的诊断与治疗

目的 探讨巨大甲状腺肿合并气管软化的诊断及手术治疗.方法 回顾性分析1992-2004年本院收治的36例巨大甲状腺肿合并气管软化的临床资料.所有病例均在术前行瓦-米试验摄片.甲状腺切除术后行气管悬吊,其中2例加行气管切开.结果 患者的瓦-米试验均阳性.术中探查：局部受压处气管软骨环消失2例,气管软骨环变细、变薄、变软34例.34例甲状腺切除术后行单一气管悬吊患者获得临床治愈.2例气管悬吊加气管切开患者抢救成功.无手术死亡.32例获随访,随访时间6个月至13年,30例均无呼吸道梗阻症状,2例死于与手术无关的疾病.结论 巨大甲状腺肿合并气管软化的诊断有赖于瓦-米试验和术中探查.甲状腺切除术后气管悬吊是治疗巨大甲状腺肿合并气管软化的有效方法.     

巨大甲状腺肿手术治疗的若干问题

目的 总结巨大甲状腺肿手术治疗的特点。方法 回顾分析295例巨大甲状腺肿的临床资料。结果 术前295例的X线平片均显示气管受压、移位、弯曲，其中l62例(54．9％)气管腔狭窄。伴明显呼吸困难者5l例(17．3％)。胸骨后甲状腺肿2l例(7．1％)。表现为继发性甲状腺功能亢进症(甲亢)l2例(4．1％)。295例均行甲状腺大部切除或甲状腺全切除术。术后病理诊断均为结节性甲状腺肿(100％)，包括合并癌变ll例(3．7％)，继发性甲亢l2例(4．1％)，甲状腺腺瘤39例(15．1％)。结论巨大甲状腺肿手术应选择合适的麻醉方法；对甲状腺主要血管、甲状腺上极过高、胸骨后甲状腺肿、癌变者应根据术中情况作不同的相应处理，以避免大出血和喉返神经损伤。对有气管切开适应证者应行气管切开。     

120例巨大甲状腺肿的外科治疗

目的：探讨巨大甲状腺肿外科治疗的特点与治疗要点。方法：收集我院17年间收治的甲状腺肿物患者3200例,并将重量在500g以上、肿块直径8cm以上的巨大甲状腺肿患者120例进行回顾研究。结果：巨大甲状腺肿占同期病例的3.8%。其中102例行一侧甲状腺叶切除加对侧次全切除,18例行甲状腺全切术,其中12例行甲状腺全切加颈部淋巴结清扫术。病理诊断105例为结节性甲状腺肿,甲状腺癌15例（12.5%）,继发甲亢者20例（16.2%）。术后出现并发症者44例,其中包括术后甲状腺功能低下30例,甲状旁腺功能低下5例,单侧喉返神经损伤7例,双侧喉返神经损伤1例,气管软化塌陷1例,无死亡病例。结论：巨大甲状腺肿可合并胸骨后甲状腺肿,可压迫气管,使气管移位变窄,手术操作难度大,风险较高,并发症多。应选择合适的麻醉方法,根据不同情况作不同处理,避免大血管和喉返神经的损伤。     

胸内甲状腺肿的外科治疗（附78例分析）

目的 回顾总结胸内甲状腺肿临床特征及外科治疗，提供临床经验。方法 本组78例患者中，男30例，女48例，平均年龄59岁病灶颈胸相连者68例，完全位于胸内10例。主要症状：气管、食管压迫症状占大多数；4例有甲亢症状，无症状10例，16例既往有甲状腺手术史，全组均行手术治疗。切口选择颈低位领式切口50例，低位领式切口加正中劈开胸骨12例，正中劈开胸骨8例，右后外侧切口6例，左后外切口加领式切口2例。结果 全组无手术死亡，喉返神经损伤3例，术后出现气管软化2例。病理：腺瘤48例，异位甲状腺10例，结节状甲状腺肿5例，甲状腺钙化结节2例，甲状腺局部癌变6例，甲状腺髓样癌4例，转移性甲状腺癌3例。结论 及时的手术是治疗胸内甲状腺肿唯一安全有效的方法。     

巨大甲状腺肿手术体会

目的总结巨大甲状腺肿外科治疗的经验。方法回顾性分析21例巨大甲状腺肿行外科治疗的患者临床资料。结果良性14例,恶性7例;肿块直径平均16(10~21)cm;行单纯肿块切除17例,甲状腺癌根治术3例,姑息切除1例。全组术中大出血1例(4.8%),术后出血1例(4.8%),3例(14.2%)术后出现甲状旁腺功能低下,经补钙等处理,术后3个月均恢复。4例(19.0%)甲状腺功能低下,1例(4.8%)甲状腺癌根治术后出现声音嘶哑,随访2年呈代偿性恢复,无手术死亡。结论完善的术前准备、术前评估,充分显露术野,细致操作,有效地控制和预防出血等均是巨大甲状腺肿手术成功的重要保证。     

169例结节性甲状腺肿与甲状腺癌并存的诊治体会

目的　探讨结节性甲状腺肿与甲状腺癌并存时的诊治方法。方法　回顾性分析我院 196 1～ 2 0 0 0年手术治疗的 4 6 2 2例结节性甲状腺肿病例中 16 9例并存甲状腺癌患者的临床资料。结果　患者平均年龄 (42 .71±12 .96 )岁 ,病程平均 19.15年 ;4 3例出现短期内颈部肿块快速长大 ,32例有气管受压症状 ,2 7例出现声音嘶哑 ;行超声检查 10 5例 ,提示甲状腺癌者 5 2例 ;行放射性核素扫描检查 38例 ,2 4例显示甲状腺内凉结节或冷结节 ;行术前细针穿刺细胞学检查 18例 ,找到癌细胞 11例。术前确诊率为 12 .4 3%。术中行快速病理检查 5 7例 ,5 5例诊断为甲状腺癌。结论　在结节性甲状腺肿临床表现的基础上出现颈部肿块增长迅速、气管受压、声音嘶哑等症状时应高度怀疑结节性甲状腺肿与甲状腺癌并存 ;甲状腺彩色超声多普勒、甲状腺核素扫描、细针穿刺细胞学等检查对诊断本病有重要意义 ;术前检查怀疑甲状腺癌者术中应行快速冰冻切片病理检查 ,可有效避免再次手术     

Ⅰ型结节性甲状腺肿16例临床分析

目的探讨Ⅰ型结节性甲状腺肿(不完全型坠入性胸骨后甲状腺肿)的诊治体会。方法选取2012-01—2016-04收治的16例Ⅰ型结节性甲状腺肿患者,均在气管插管全麻下取低位"领口状"切口实施"带状肌帘状开窗术"。其中患侧甲状腺叶切除术4例,双侧甲状腺次全切除7例;一侧腺叶、峡部全切加对侧腺叶次全切除5例。结果本组16例患者均成功完成手术。病理学检查结果证实为结节性甲状腺肿。术后1例出现声音嘶哑、2例出现低钙症状,经对症治疗后恢复正常,其余患者均顺利康复出院。结论胸骨后甲状腺肿易压迫气管、食管和颈深部大静脉,故需手术治疗。Ⅰ型结节性甲状腺肿均可通过颈部低位"领口状"切口和"带状肌帘状开窗术"完成手术,不需劈开胸骨。应根据术前影像学检查结果及术中探查情况,个体化选择术式。     

巨大甲状腺肿的手术切除体会

目的 探讨影响巨大甲状腺肿手术成功的因素.方法 对24例巨大甲状腺肿患者术前进行多学科讨论,手术方式为甲状腺全切除术或近全切除术,并对大部分病例随访1年余.结果 24例患者均顺利完成手术治疗.手术时间60～120min,平均85min.术中出血20～60ml,4例给予气管悬吊术,3例术中行气管切开术,2例出现暂时性喉返神经麻痹,2例出现口唇麻木感,术后住院时间5～14d,平均7d.结论 完善的术前检查,必要的术前准备,多学科讨论,正确的手术方式,术中良好的暴露以及细致的操作,是切除巨大甲状腺肿,减少术中出血,控制术后并发症的重要保证.     

气管悬吊术预防及治疗气管软化症

我院于1975年至1994年共进行469例甲状腺次全切除术，对其中37例气管软化明显者做了气管悬吊术，取得满意效果，现报告如下。临床资料一、一般资料本组37例中，其中男性7例，女性30例；病程长者30年，最短者1年。地方性甲状腺肿16例，甲克7例，巨大甲状腺腺瘤14例。除7例有甲克     

颈胸联合操作治疗胸骨后巨大甲状腺肿的体会

目的：探讨胸骨后巨大甲状腺肿围手术期处理,手术方式选择及诊治要点。方法回顾分析2008年至2013年全部采用颈部低领式切口加胸骨劈开术式的11例患者资料,总结围手术期诊治要点。结果所有病例通过增强 CT、多面重建及三维重建等得到了完备的术前评估。所有病例肿瘤直径大于10 cm,胸骨后下坠位置超过主动脉弓平面,均出现气管压迫或移位;9例瓦米（Valsalva-Mueller,V-M）试验阳性;5例合并甲亢,术前准备超过1个月。术前评估均为高危。术中因肿瘤巨大及粘连而导致不同程度的操作困难。术后均送往外科 ICU 拔管并留观至少24 h。1例行气管切开;1例因创面渗血二次手术;气胸1例;所有病例出现不同程度暂时性喉返神经损伤;4例暂时性甲旁腺功能低下,永久性功能低下1例;未出现气管塌陷及呼吸困难。结论完善的术前影像检查尤其是 CT 扫描及三维重建对于巨大胸骨后甲状腺肿的诊治至关重要,对于肿瘤过大下坠位置超过主动脉弓平面者应果断选取颈部低领式切口加胸骨劈开术。开阔的术野更有利于操作,避免并发症。     

Tracheomalacia from compressing goiter: management after thyroidectomy

Tracheomalacia may result from prolonged compression by expanding goiter, particularly within the confines of the thoracic inlet. Constriction of the upper airway by the growing goiter may be indication for operation, but the residual problem of tracheomalacia after thyroidectomy is a life-threatening postoperative complication. Examples of postoperative tracheomalacia in patients with neglected goiters endemic in the third world or recurrent goiter with airway compromise in a western medical center referral practice are described for development of management methods. Two patients with lethal postthyroidectomy tracheomalacia led me to anticipate this complication in certain identifiable high-risk patients in my own practice, and the cases of five patients are described for whom several techniques of tracheal support were attempted. One patient, for whom staged tracheoplasty was planned, opted for tracheostomy, whereas four patients have had adequate tracheal airways restored by extrinsic support. One was treated by subtotal thyroidectomy with tracheal suspension; one by staged thyroid reductions; two were treated by creation of extrinsic tracheal neo-rings constructed of surgical wire and vascular prostheses. The patient with the most dramatic airway impairment from the most extensive tracheomalacia experienced very satisfactory airway security. A second patient was also supported by the prosthetic rings but extruded one of them, possibly because of tracheostomy contamination. Until tracheal replacement or better tolerated prosthetic or biologic supports are devised, tracheomalacia will remain a vexing problem complicating thyroidectomy for long-standing or recurrent airway-compressing goiter.     

Tracheopexy for tracheomalacia complicating a giant multinodular goiter: a case report

Tracheomalacia is a rare complication that may occur in patients undergoing thyroidectomy for a along-standing goiter. A case of tracheomalacia due to compression of the trachea with a giant multinodular goiter is reported. Following total thyroidectomy the tracheal ring was fixed bilaterally to periosteum of sternal end of the clavicle. This method of tracheopexy was effective in management of this particular patient.     

Tracheopexy for Tracheomalacia Complicating a Giant Multinodular Goiter: A Case Report

Tracheomalacia is a rare complication that may occur in patients undergoing thyroidectomy for a along-standing goiter. A case of tracheomalacia due to compression of the trachea with a giant multinodular goiter is reported. Following total thyroidectomy the tracheal ring was fixed bilaterally to periosteum of sternal end of the clavicle. This method of tracheopexy was effective in management of this particular patient.     

High Incidence of Tracheomalacia in Longstanding Goiters: Experience from an Endemic Goiter Region

Background Our institute caters to a large number of patients with large, longstanding multinodular goiters; tracheal deviation and resulting airway problems like tracheomalacia are relatively common. However, the literature is sparse on the criteria of early diagnosis and optimum management of tracheomalacia, which our study highlights. Methods This retrospective study analyzed 900 thyroidectomies carried out during 1990–2005 for which data from 28 patients treated for tracheomalacia after thyroidectomy were available for analysis. Criteria for making a diagnosis of tracheomalacia after thyroidectomy included one or more of the following: normal vocal cord mobility, absence of glottic or subglottic edema or hematoma, soft and floppy trachea on palpation, obstruction to spontaneous respiration on gradual withdrawal of the endotracheal tube. Results Mean duration of thyroid enlargement was 13.75 years. Only 7 patients had a history of stridor. Tracheostomy was performed in 26 patients, and 2 patients were put on prolonged intubation. Tracheostomy was performed in 18 patients on the operating table, and 8 in the recovery room. The mean weight of the gland was 442 g and histopathology revealed that 11 cases were benign goiter. The tracheostomy tube was removed after an average of 8.5 days. There were no cases of tracheal stenosis on long-term follow-up. Conclusions Patients with longstanding goiter, even when benign, are more prone to develop tracheomalacia. On the basis of our experience we strongly advocate tracheostomy intraoperatively if the trachea is soft and floppy and/or collapse of the trachea is observed following gradual withdrawal of the endotracheal tube.     

自主功能性甲状腺结节104例临床分析

目的提高对自主功能性甲状腺结节（ＡＦＴＮ）的诊断与治疗水平。方法１０４例ＡＦＴＮ中同位素结合促甲状腺激素刺激扫描诊断１６例,结合甲状腺激素抑制扫描诊断２０例,结合手术前后扫描诊断６８例。全部病例均行手术治疗,手术方式有单纯结节摘除,一叶部分或全切除,双叶次全切除及癌根治术。结果１０４例ＡＦＴＮ中,同位素扫描为“热结节”者９４例,“温结节”者１０例,继发甲状腺机能亢进２５例（２４％）,７６例来自地方性甲状腺肿流行区。病理类型：结节性甲状腺肿７６例（７３１％）,甲状腺腺瘤２６例（２５０％）,甲状腺癌２例（１９％）。对２６例ＡＦＴＮ患者进行术后３～２２年随访,未发现结节复发及甲低等并发症。结论碘缺乏可能在ＡＦＴＮ形成中起重要作用;同位素扫描是诊断ＡＦＴＮ的主要手段;ＡＦＴＮ患者一旦确诊应及时治疗,手术是较好的治疗方法。     

结节性甲状腺肿合并分化型甲状腺癌诊断与治疗

目的：探讨结节性甲状腺肿合并分化型甲状腺癌的临床特点及诊治原则。 方法：回顾性分析2003年10月—2011年10月收治的47例结节性甲状腺肿合并分化型甲状腺癌的临床资料。 结果：患者均表现为颈部包块或颈部增粗,术前B超显示结节伴细沙粒样钙化者19例（40.43%）。47例患者均行手术治疗,术后经病理学检查确诊为分化型甲状腺癌（其中乳头状癌36例,占76.60%;滤泡样癌11例,占23.40%）,手术方式包括：患侧腺叶+峡部全切术+VI区淋巴结清扫;两侧腺叶+峡部全切术+VI区淋巴结清扫;颈部淋巴结肿大、转移者加行改良颈清扫术。术后均给予左旋甲状腺素片治疗。47例患者术后随访6~36个月,平均为（15.6±8.9）个月,3例分别于术后16~33个月复发,再次手术,效果良好。全组无死亡病例。 结论：结节性甲状腺肿合并甲状腺癌术前诊断困难,术前超声检查可提供可考依据,术中快速冷冻切片病理学检查是提高甲状腺癌检出率的关键;个体化、精细规范的手术治疗对结节性甲状腺肿合并分化型甲状腺癌有良好的治疗效果。     

Nodular goiter and cancer of the thyroid

Among 3229 patients with diseases of the thyroid gland aged from 6 to 83 years there were 2924 patients who had nodular forms of goiter and 71 patients who had malignant tumors of the thyroid. Thyroidolymphography with aimed trepanbiopsy was used to make more exact diagnosis. Complex clinico-radiological examination, thyroidolymphography with aimed biopsy before operation are considered to facilitate making more exact diagnosis and choosing the adequate treatment.