摘要
目的探讨胸骨后甲状腺病变的临床表现、诊断方法和手术治疗。方法回顾性分析我院1999年1月至2005年6月收治的47例胸骨后甲状腺肿的临床资料。结果46例为Ⅰ°坠人性胸骨后甲状腺肿,均为部分型,1例为Ⅱ°异位胸内甲状腺肿。良性病变45例,恶性病变2例。均行手术治疗,43例采用颈部低领式切口,3例采用颈部低领式切口+部分胸骨劈开,1例行胸骨劈开。行甲状腺大部切除术31例,双侧甲状腺次全切除术14例,甲状腺癌根治术1例,甲状腺癌姑息切除术1例。全组无手术及住院死亡,声嘶恢复正常5例,声嘶无改善2例,一过性手足抽搐4例,1例甲状腺鳞状细胞癌术后一月因肿瘤局部复发堵塞气管窒息死亡。结论绝大多数胸骨后甲状腺病变是颈部病变向下延续所致。CT扫描是最佳的术前检查手段。绝大多数患者的手术可经颈部低领式切口完成,必要时附加胸骨部分劈开。
Objective To investigate the clinical characteristics, diagnosis and surgical treatment of substernal goiter. Methods Clinical data of 47 cases of subternal goiter from Jan 1999 to Jun 2005 were retrospectively analyzed. Result There were 46 cases of type Ⅰ° of discending subternal goiter and 1 case of type Ⅱ° of truly ectopic intrathoracic thyroid. Subtotal thyroidectomy was performed in 31 cases, 14 cases underwent near total thyroidectomy, 1 case of thyroid cancer received radical resection and 1 case received cancer palliative excision. 43 were operated through low cervical incision, 3 with combined cervico-partial sternotomy and 1 with thoracotomy. Pathology identified benignity in 45, malignancy in 2. Preoperative hoarseness disappeared in 5 patients, while it did not improve in the other 2 patients. Four patients experienced transient hypocalcemia after operation. One patient died within a month after palliative thyroidectomy for tumor recurrence. Conclusion Substernal goiters often result from the descent of a cervical goiter with the primary blood supply from the neck. CT scanning is valuable in the diagnosis of substernal goiter. Most substernal goiters can be removed successfully through a transcervical approach, although partial upper sternotomy is occasionally required.
出处
《中华普通外科杂志》
CSCD
北大核心
2006年第9期644-646,共3页
Chinese Journal of General Surgery
