胸内甲状腺肿的诊断与手术治疗

目的　探讨胸内甲状腺肿的临床诊断与手术治疗方法。方法　回顾分析经术后病理证实为胸内甲状腺肿 2 8例。结果　术前明确诊断 2 4例 ( 86% )。坠入性胸内甲状腺肿 2 6例迷走性胸内甲状腺肿 2例。手术入路分别为颈部领式切口 11例 ,低位领式切口加胸骨正中切开 9例 ,开胸法 6例 ,颈胸联合切口 2例。术后并发症 3例 ( 10 .7% ) ,为出血和喉返神经损伤。结论　X线胸片、CT检查、同位素扫描是主要诊断手段。手术切除是胸内甲状腺肿首选治疗方法。应根据肿物不同情况选择合适的手术径路。出血和喉返神经损害是术后主要并发症 ,可通过术中防范措施来预防。

Diagnosis and treatment of intrathoracic goiter

Objective To study the clinical diagnosis and surgical treatment of intrathoracic goiters.Methods 28 cases of intrathoracic goiter proved pathologically were retrospectively analysed.Results There were 24 cases (86.9%) definitely diagnosed prier to operation.In all of these 28 cases of intrathoracic goiter reported herein 26 cases were classified as"down-falling"type while 2 cases the"wandering"type.The operative approaches used in 11 cases were collar incision over the neck,in 9 cases low collar incision with cutting the sternum open along the median line,and in 6 cases thoracotomy being performed.The other two cases underwent a combined jugulothoracic procedure.Postoperative complications occurred in 3 cases (10.7%) including hemorrhage and damage to recurrent laryngeal nerve.Conclusions Chest roentgenographes,CT and isotope scans are of importance in diagnosis. The first choice of treatment in intrathoracic goiter is surgical intervention and the approach used should be selected according to the status of the mass.Hemorrhage and damage to recurrent laryngeal nerve are major postoperative complications which can be avoided by means of preventive measures reported.