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。

Problems of operations for huge goitres

Objective To sum up the problems should be taking care in operations for huge goitres. Methods Retrospectively analyzed the clinical data of 295 cases of huge goitres was made. Results All of the 295 cases had some degree of compress, replacement and bend of trachea by the goitre comfirmed by X ray examination .Among the 295 cases,162(54.9%) had trachea constriction.51(17.3%) had obvious dyspnea. Retrosternal goitres was found in 21 cases.12 complicated with secondary hyperthyroidism. All the 295 cases underwent subtotal or total thyroidectomy. Postoperative pathological diagnosis: nodular goitres was diagnosed in all the 259 cases (100%),including 11 cases(3.7%) with malignancy, 12 cases( 4.1% ) with secondary hyperthyroidism,and 39(15.1%) with adenomas. Conclusions Operation of huge goitres should choice appropriate anaesthetic method.For the main vessels of thyroid, very high position of the upper pole of thyroid, retrosternal goitres, malignancy of goitres etc,appropriate operative measures shoudd be adopted to prevent introoperative massive bleeding and damage of recurrent laryngeal nerve. If the indications of tracheostomy presents,a tracheostomy must be done.