老年胸骨后甲状腺肿瘤外科治疗

目的探讨老年胸骨后甲状腺肿瘤的手术入路方法。方法采用颈部低领式切口入路,按甲状腺常规切除方法进行。对于坠入上纵隔较深的肿瘤采用“共力牵引”法,而对于甲状腺癌需进行上纵隔暴露及淋巴结清扫的病例,采用咬除锁骨内1/3及部分胸骨的方法,充分暴露上纵隔。结果22例老年胸骨后甲状腺肿瘤采用低领式切口入路均获成功。无手术并发症。随访率100%,随访29个月,无复发病例。结论采用颈部低领式切口入路完成老年胸骨后甲状腺肿瘤切除具有创伤小,时间短,并发症少的优点。“共力牵引”法方便了术中暴露。甲状腺恶性肿瘤采用咬除锁骨内1/3及部分胸骨的方法,可充分暴露上纵隔。

Surgically therapy of substernal thyroid goiter in the elder

OBJECTIVE To Study the surgical approaches and operative techniques for removal of substernal thyroid neoplasms in the old patients. METHODS The collar incision in the lower neck as in routine thyroidectomy was used. For tumors protrud- ing deep into the superior mediastinum(SM), a method called "dragging all together" was used to explore and remove the tumors. For the thyroid carcinomas involv- ing SM, exposure of SM along with radical neck dis- section was used. RESULTS Retrosternal thyroid tu- mors were successfully removed in 22 cases without operation related complications. No recurrent tumors were encountered after follow-up for 2 years and 5 months. CONCLUSION The operative procedure used in this study was less traumatic, less time-consuming and less complications. The method of "dragging all together" made the exposure of surgical field easier. Resection of internal 1/3 of clavicle can expose the superior mediastinum.