胸骨后甲状腺肿98例外科治疗分析

目的分析探讨不同分型胸骨后甲状腺肿的外科治疗和人路选择。方法回顾性分析98例胸骨后甲状腺肿患者的临床资料，其中结节性甲状腺肿89例，滤泡性甲状腺腺瘤8例，甲状腺乳头状癌1例。SINGHI型37例，Ⅱ型56例，Ⅲ型5例；全部I型和55例Ⅱ型均行颈部低领式切口，1例Ⅱ型为恶性并周围粘连明显行颈胸联合切口，Ⅲ型行颈胸联合切口。术中常规显露喉返神经；28例使用超声刀配合手术。结果98例患者手术均获成功，术后4例并发短暂的低钙血症，3例短暂声嘶，8例甲状旁腺功能减退。结论I型和Ⅱ型胸骨后甲状腺肿患者采用颈部低领式切口是可行的，胸骨后甲状腺肿为恶性并周围粘连明显以及Ⅲ型行颈胸联合切口是必要的。术中常规显露喉返神经对于减少喉返神经损伤具有重要意义。应用超声刀行胸骨后甲状腺肿切除术，减少手术时间及术中出血量，是安全、有效的手术方法。

Experience of the surgical treatment of ninty-eight cases with substernal goiter

Objective To summarize the experience of surgical treatment of substernal goiter. Methods The clinical data of 98 patients diagnosed of substernal goiter were retrospectively analyzed. Among them, eighty nine were confirmed to be nodular goiter by pathology, eight were follicular thyroid adenoma and one was papillary thyroid carcinoma. According to SINGH, 37 belonged to Type Ⅰ, 56 Type Ⅱ, and 5 Type Ⅲ. Ninty-two patients underwent low neck and collar-type incision, and 6 were given low neck and collar-type incision plus partial sternotomy. Recurrent laryngeal nerve was unveiled generally. Results All the operations were successful. The postoperative complications included transient hypocalcemia（4 cases）, trachyphonia（3 cases）, and hypothyroidism（8 cases）. Conclusions It is feasible for Type I and 1I substernal goiter to be treated with low neck and collar-type incision. The visual identification of recurrent laryngeal nerve is essential to prevent recurrent laryneal nerve damage. Use of harmonic scalpel in substernal goiter surgery can reduce the volume of bleeding and operation time. It is safe and effective in substernal goiter surgery.